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Objective Duodenal mucosal ablation (DMA) is a novel endoscopic therapy that aims to selectively and reversibly destroy the abnormal hypertrophied duodenal mucosa in patients with inadequately controlled type 2 diabetes mellitus (T2DM) by improving glycated haemoglobin (HbA1c). We conducted a systematic review and meta-analysis to evaluate the pooled efficacy and safety of DMA across the three currently available technologies.Design/method We searched Medline, Cochrane and Scopus databases for studies reporting outcomes on DMA up to June 2024. The primary outcome was mean HbA1c reduction within 6 months post-procedure and the secondary outcome was the pooled rate of serious adverse events (SAEs). Meta-analyses were performed using a random-effects model, with results reported as percentages and 95% confidence intervals (CIs).Results Eight studies (341 patients) were included, evaluating both thermal (REVITA, RFVA) and non-thermal (ReCET) ablation technologies. In patients with inadequately controlled T2DM, the mean HbA1c reduction at 6 months was −1.13% (95% CI −1.37% to −0.89%; I²=93%, p<0.001). SAEs were uncommon, occurring in 0.0%–14.3% with a pooled rate of 2.0% (95% CI 0.0% to 5.0%; I 2=10.2%, p=0.35). Meta-regression, after adjustment for outliers, was unable to fully account for the observed heterogeneity, suggesting the influence of unmeasured confounders such as lifestyle management.Conclusions DMA offers a consistent glycaemic benefit in inadequately controlled T2DM across multiple technologies, with a favourable and evolving safety profile. While procedural refinements, such as increasing ablation length, may enhance efficacy, these must be addressed in parallel with patient-level factors to minimise variability and optimise treatment outcomes.