S2245 Duodenal Mucosal Resurfacing for Glycemic and Metabolic Improvement in Insulin-Resistant Patients: A Meta-Analysis of Randomized Controlled Trials and Observational Studies

Introduction: Endoscopic duodenal mucosal resurfacing (DMR) is a minimally invasive endoscopic procedure designed to improve glucose metabolism by ablating the duodenal mucosa. While both randomized and non-randomized studies suggest metabolic benefits, the evidence base remains limited and inconsistent. This meta-analysis evaluates the impact of DMR on glycemic control, insulin sensitivity, and broader metabolic parameters in insulin-resistant overweight patients. Methods: We conducted a systematic search of PubMed, Embase, and the Cochrane from inception to March 2025. Eligible studies included both randomized controlled trials (RCTs) and observational therapeutic trials assessing DMR in insulin-resistant and overweight adults. Primary outcomes were changes in HbA1c, HOMA-IR, and weight. Secondary outcomes included ALT, AST, HDL, systolic blood pressure (SBP), fasting glucose, and fasting insulin. Meta-analysis was performed using a random-effects model. Results: Four studies (2 RCTs and 2 observational trials) with a total of 143 participants met the inclusion criteria. DMR significantly reduced HbA1c in patients with diabetes (–1.18%, 95% CI: –1.37 to –1.00) and showed a non-significant reduction in the overall population (–0.80%, 95% CI: –1.81 to 0.20) at 24 weeks. HOMA-IR improved significantly (–1.14, 95% CI: –2.22 to –0.06), and body weight decreased by –2.50 kg (95% CI: –2.54 to –2.46) at 24 weeks. Directionally favorable but statistically non-significant changes were observed in ALT (–9.87 U/L), AST (–2.78 U/L), SBP (–3.83 mmHg), HDL (+6.90 mg/dL), fasting plasma glucose (–29.66 mg/dL), and fasting plasma insulin (–9.64 amol/L). Adverse events were rare and generally mild. Unpooled outcomes, including C-peptide, liver fat, and hormonal AUC metrics, also showed favorable trends. Conclusion: DMR significantly improves glycemic control, insulin sensitivity, and body weight in insulin-resistant patients, particularly those with type 2 diabetes. Although secondary metabolic markers demonstrated promising trends, they did not reach statistical significance. The procedure appears safe, with minimal and manageable adverse events. These findings underscore DMR’s potential as a therapeutic option for metabolic disease. Larger, high-quality multicenter RCTs are warranted to confirm its long-term efficacy and safety. ChatGPT (OpenAI) was used for language clarity and grammar refinement. All scientific content, data, and analysis are original and solely by the authors.