Metabolic Improvement and Weight Reduction After Large Endoscopic Submucosal Dissection Including the Papilla for Duodenal Adenoma: A Case Report.

Endoscopic submucosal dissection (ESD) has become an established therapeutic approach for duodenal adenomas, although it is technically demanding. Duodenal mucosal resurfacing (DMR) is an emerging endoscopic metabolic therapy designed to ablate and regenerate duodenal mucosa. To date, no reports have described ESD including the papilla (ESDIP) producing similar metabolic effects to DMR. A 36-year-old Asian man with an elevated body mass index of 30.16 kg/m2 was diagnosed with a large duodenal laterally spreading tumor, measuring 80 × 70 mm in size and extending to the major papilla. Water-pressure method-assisted ESDIP was performed with en bloc resection, and histopathology demonstrated a tubulovillous adenoma with low-grade dysplasia and uninvolved margins. Remarkably, during the 2- and 8-week follow-up periods, the patient exhibited reductions in total body weight of 5.9% and 7.9%, respectively, and a marked improvement in glycemic control, with fasting blood glucose decreasing from 210 to 113 mg/dL despite no changes in lifestyle or medication. These metabolic improvements suggest a possible clinical overlap between extensive duodenal mucosal resection via ESDIP and DMR. However, given the limitations of a single case, these findings warrant cautious interpretation and further study to clarify the underlying mechanisms.