P3539 - Comparison Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy for Small Superficial Duodenal Adenomas: A Systematic Review and Meta-Analysis

Ghulam Ali Hasnan, MBBS¹, Aamir Saeed, MD², Marjan Haider, MD³, Hafsa Riaz, MBBS⁴, Aeman Nisar, MD⁵, Muhammad Kamal, MD⁶, Saira Yousuf, MD², Amman Yousaf, MD⁷, Soban Jaffar, MBBS⁸, Sam Dabit, ⁹, Muhammad Waqar Elahi, MD¹⁰, Awais aslam, MBBS¹¹, Bilal Aman, MBBS¹², Sultan Mahmood, MD¹³, Faisal Kamal, MD¹⁴
1Dr Grays Hospital NHS Grampian, Elgin, Scotland, United Kingdom; 2Vanderbilt University Medical Center, Nashville, TN; 3Trinity Health Ann Arbor Hospital, Ypsilanti, MI; 4Services Hospital Lahore, Lahore, Punjab, Pakistan; 5Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; 6Hackensack Meridian Health, Edison, NJ; 7Hattiesburg Clinic, Hattiesburg, Hattiesburg, MS; 8Services Hospital , Lahore, Lahore, Punjab, Pakistan; 9South Central Regional Medical Center, Laurel, MS; 10West Virginia University School of Medicine, Morgantown, WV; 11Russells Hall Hospital, Dudley, England, United Kingdom; 12Tameside General Hospital, Manchester, England, United Kingdom; 13University of Pittsburgh Medical Center, Pittsburgh, PA; 14Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA

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% (Figure1, 2).

Discussion: 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.


Figure: Figure 1: Comparison of delayed bleeding between the groups


Figure: Figure 2: Comparison of procedure time between the groups

Disclosures:
Ghulam Ali Hasnan indicated no relevant financial relationships.
Aamir Saeed indicated no relevant financial relationships.
Marjan Haider indicated no relevant financial relationships.
Hafsa Riaz indicated no relevant financial relationships.
Aeman Nisar indicated no relevant financial relationships.
Muhammad Kamal indicated no relevant financial relationships.
Saira Yousuf indicated no relevant financial relationships.
Amman Yousaf indicated no relevant financial relationships.
Soban Jaffar indicated no relevant financial relationships.
Sam Dabit indicated no relevant financial relationships.
Muhammad Waqar Elahi indicated no relevant financial relationships.
Awais aslam indicated no relevant financial relationships.
Bilal Aman indicated no relevant financial relationships.
Sultan Mahmood indicated no relevant financial relationships.
Faisal Kamal indicated no relevant financial relationships.

Ghulam Ali Hasnan, MBBS¹, Aamir Saeed, MD², Marjan Haider, MD³, Hafsa Riaz, MBBS⁴, Aeman Nisar, MD⁵, Muhammad Kamal, MD⁶, Saira Yousuf, MD², Amman Yousaf, MD⁷, Soban Jaffar, MBBS⁸, Sam Dabit, ⁹, Muhammad Waqar Elahi, MD¹⁰, Awais aslam, MBBS¹¹, Bilal Aman, MBBS¹², Sultan Mahmood, MD¹³, Faisal Kamal, MD¹⁴. P3539 - Comparison Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy for Small Superficial Duodenal Adenomas: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.