{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:19:15Z","timestamp":1787638755345,"version":"build-2736575974"},"reference-count":42,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Study Aim<\/jats:title>\n                    <jats:p>Underwater endoscopic submucosal dissection (U\u2010ESD) has recently been introduced as a technique that may improve visualization and submucosal layer expansion. However, the clinical outcomes of U\u2010ESD for duodenal tumors have not been systematically evaluated. This study aimed to assess the efficacy and safety of U\u2010ESD for duodenal tumors through a systematic review and meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library from database inception to December 12, 2025. Studies evaluating U\u2010ESD for duodenal tumors were included. Primary outcomes included en bloc resection, R0 resection, procedure time, adverse events, and complete mucosal defect closure. Pooled estimates were calculated using a random\u2010effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four retrospective studies comprising 298 lesions treated with U\u2010ESD were included. The pooled procedure time was 59\u2009min (95% CI, 48\u201370\u2009min;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200972%). The pooled en bloc resection rate was 99% (95% CI, 97%\u2013100%;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), and the pooled R0 resection rate was 89% (95% CI, 81%\u201393%;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200954%). The pooled intraoperative perforation rate was 5% (95% CI, 1%\u201323%;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200988%). The pooled delayed perforation and delayed bleeding rates were 1% (95% CI, 0%\u20133%;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%) and 2% (95% CI, 1%\u20135%;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current evidence suggests that U\u2010ESD is a feasible treatment option for duodenal tumors and is associated with favorable clinical outcomes. However, the available evidence remains limited, and potential biases and concerns regarding generalizability warrant cautious interpretation of these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70247","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:36:28Z","timestamp":1785256588000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes of Underwater Endoscopic Submucosal Dissection for Duodenal Tumors: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2960-6690","authenticated-orcid":false,"given":"Kumiko","family":"Kirita","sequence":"first","affiliation":[{"name":"Division of Research and Development for Minimally Invasive Treatment Cancer Center Keio University School of Medicine  Tokyo 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