S2248 Comparison Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy for Small Superficial Duodenal Adenomas: A Systematic Review and Meta-Analysis

Introduction: Underwater endoscopic mucosal resection (UEMR) and cold snare polypectomy (CSP) are novel endoscopic procedures for superficial non ampullary duodenal epithelial tumors (SNADET). However, consensus on how to use both procedures appropriately has not been established. We conducted a meta-analysis to evaluate comparative outcomes of U-EMR and CSP in superficial duodenal adenomas. Methods: Several databases were reviewed from inception to March 01, 2025, to identify studies comparing the outcomes of U-EMR vs CSP in superficial duodenal adenomas. Our outcomes of interest was en bloc resection, R0 resection, local recurrence, perforation, delayed bleeding, and procedure time. We calculated risk ratios (RRs) with 95% CI for categorical variables and mean differences with 95% CI for continuous variables. Data was analyzed using the random effect model. Heterogeneity was assessed using I 2 statistics. Results: We included 4 studies with 1144 patients (U-EMR 750, CSP 394) in our analysis. The mean age of the patients was 64.9 (3.8) years, and the mean lesion size was 7.8 (2.6) mm. Comparative analysis of U-EMR and CSP found no significant difference in rates of en bloc resection, RR (95% CI): 0.94 (0.87,1.03) P = 0.17, I2 58%, R0 resection, RR (95% CI): 1.26 (0.96,1.66) P = 0.10, I2 70% , perforation, RR (95% CI): 2.92(0.16,53.93) P = 0.47, and local recurrence, RR (95% CI): 1.02 (0.22, 4.69) P = 0.98, I2 0%. U-EMR was associated with higher rates of delayed bleeding, RR (95% CI): 4.01 (1.06,15.17) P = 0.04, I2 0%, and longer procedure time as compared to CSP, MD (95% CI): 10.73 (5.68,15.77) P < 0.0001, I2 99%. Conclusion: Our meta-analysis demonstrates that U-EMR is associated with higher rates of delayed bleeding and longer procedure time as compared to CSP in small superficial duodenal adenomas. Future multicenter studies are needed to validate these findings further.