Abstract
<title>Abstract</title> <p> <bold>Introduction</bold> Endoscopic approaches have been introduced for weight loss and metabolic disease management. Duodenal mucosal resurfacing (DMR) is an emerging endoscopic technique used to treat these conditions. This meta-analysis aims to evaluate the efficacy and safety of DMR. <bold>Methods</bold> We searched PubMed, Scopus, and Cochrane databases up to November 2025. The primary outcomes were weight loss, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and urine microalbumin levels, with follow-up periods up to 24 months. Secondary outcomes included C-peptide, fasting insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score, liver function, lipid profiles, adverse events, and patient-reported treatment satisfaction. A subgroup analysis was conducted specifically for patients with type 2 diabetes mellitus (T2DM). <bold>Results</bold> A total of 16 studies involving 356 patients who underwent DMR were included. Over 24-month follow-up, patients treated with DMR demonstrated significant weight loss (MD: –2.50 kg; 95% CI: –2.60 to –2.39) and FPG levels (MD: –2.01 mmol/L; 95% CI: –2.43 to –1.60). In subgroup analyses of T2DM, DMR was associated with significant reductions in HbA1c (MD: –0.64%; 95% CI: –1.11 to –0.16) and insulin resistance as measured by HOMA-IR (MD: –3.93; 95% CI: –6.78 to –1.09). Notably, 59% of patients remained insulin-independent at the end of the study period. Patient-reported outcomes showed favorable treatment satisfaction. <bold>Conclusion</bold> Modest but durable improvements in weight loss and glycemic outcomes were observed among patients who underwent DMR across diverse settings, with a favorable safety profile. These findings suggest DMR warrants further investigation as an adjunctive option for metabolic disease management. </p>