#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

The duodenal-jejunal bypass liner (EndoBarrier®) for the treatment of type 2 diabetes mellitus in obese patients – efficacy and factors predicting optimal effects


Authors: M. Beneš 1;  T. Hucl 1;  P. Drastich 1;  R. Keil 2;  Z. Vlasáková 3;  T. Pelikánová 3;  P. Kaválková 4;  M. Mráz 5;  Z. Lacinová 4,5;  M. Haluzík 4,6;  J. Špičák 1
Authors‘ workplace: Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha 1;  Interní klinika 2. LF UK a FN Motol, Praha 2;  Laboratoř klinické patofyziologie, Centrum diabetologie, IKEM, Praha 3;  Ústav lékařské bio­chemie a laboratorní dia­gnostiky, 1. LF UK a VFN v Praze 4;  III. interní klinika 1. LF UK a VFN v Praze6 Endokrinologický ústav, Praha 5
Published in: Gastroent Hepatol 2016; 70(6): 491-499
Category: Bariatrics
doi: https://doi.org/10.14735/amgh2016csgh.info15

Overview

Background:
The global increase in the incidence of obesity results in an increase in the incidence of type 2 diabetes mellitus (T2DM). Surgical treatment has proven to be effective; however, it carries a high risk of complications. The duodenal-jejunal bypass liner (DJBL) EndoBarrier® (GI Dynamics). is an endoscopic implant that mimics the intestinal bypass portion of the Roux-en-Ygastric bypass.

Material and Methods:
Twenty patients were included in the study. They had a mean body mass index (BMI) of 41.9 ± 1.0 kg/sqm and a mean HbA1c concentration of 73.5 ± 4.46 mmol/mol and were receiving T2DM treatment. All patients re­ceived complete bariatric support care from a professional team. The aim of this prospective multi-center study was to determine the effectiveness of the DJBL and to identify clinical factors associated with a better outcome of the DJBL.

Results:
At 10 months, there was significantly greater weight loss (119.56 ± 3.65 vs. 130.3 ± 3.6 kg; p < 0.05), BMI improvement (38.3 ± 1.01 vs. 41.9 ± 1.0 kg/sqm; p < 0.05), excess weight loss of 23%, and improvement of blood glucose levels (8.5 ± 0.5 vs. 11.9 ± 0.83 mmol; p < 0.05) and long-term diabetes compensation (HbA1c 56.5 ± 3.28 vs. 73.35 ± 4.46 mmol/mol; p < 0.05). Mild abdominal pain and nausea were experienced by 72% of patients during the first 14 days after implantation, 33% of patients during the first month, and 10% of patients after one month. Lower initial BMI, distal position of the anchor, and lower body height were identified as prognostic factors for pain.

Conclusion:
The DJBL is a safe and effective alternative to surgical bariatric procedures. Lower initial BMI and lower body height could be positive prognostic factors for the superior effect of DJBL treatment.

Key words:
bariatric endoscopy – EndoBarrier – metabolic syndrom

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
21. 3. 2016

Accepted:
13. 4. 2016


Sources

1. Centers for Disease Control and Prevention. Obesity and overweight. [online]. Available from: http:/ / www.cdc.gov/ nchs/ fastats/ obesity-overweight.htm.

2. Johnson DA. Preface. Gastroenterologic is­sues in the obese patient. Gastroenterol Clin North Am 2010; 39(1): xi– xiii. doi: 10.1016/ j.gtc.2009.12.013.

3. Nguyen DM, El-Serag HB. The epidemiology of obesity. Gastroenterol Clin North Am 2010; 39(1): 1– 7. doi: 10.1016/ j.gtc.2009.12.014.

4. Sjöström L, Narbro K, Sjöström CD et al. Ef­fects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357(8): 741– 752.

5. Morino M, Toppino M, Forestieri P et al. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg 2007; 246(6): 1002– 1007.

6. Flum DR, Del­linger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg 2004; 199(4): 543– 551.

7. Coté GA, Edmundowicz SA. Emerg­ing technology: endoluminal treatment of obesity. Gastrointest Endosc 2009; 70(5): 991– 999. doi: 10.1016/ j.gie.2009.09.016.

8. El­lsmere JC, Thompson CC, Brugge WR et al. Endoscopic interventions for weight loss surgery. Obesity (Silver Spring) 2009; 17(5): 929– 933.

9. Schouten R, Rijs CS, Bouvy ND et al. A multicenter, randomized ef­ficacy study of the EndoBar­rier Gastrointestinal Liner for presurgical weight loss prior to bariatric surgery. Ann Surg 2010; 251(2): 236– 243. doi: 10.1097/ SLA.0b013e3181bdfbf­f.

10. Kumar N. Endoscopic therapy for weight los­s: gastroplasty, duodenal sleeves, intragastric bal­loons, and aspiration. World J Gastrointest Endosc 2015; 7(9): 847– 859. doi: 10.4253/ wjge.v7.i9.847.

11. Rodriguez-Grunert L, Galvao Neto MP, Alamo M et al. First human experience with endoscopical­ly delivered and retrieved duodenal– jejunal bypass sleeve. Surg Obes Relat Dis 2008; 4(1): 55– 59. doi: 10.1016/ j.soard.2007.07.012.

12. Tarnoff M, Rodriguez L, Escalona A et al. Open label, prospective, randomized con­trol­led trial of an endoscopic duodenal-je­junal bypass sleeve versus low calorie diet for preoperative weight loss in bariatric surgery. Surg Endosc 2009; 23(3): 650– 656. doi: 10.1007/ s00464-008-0125-4.

13. Gersin KS, Rothstein RI, Rosenthal RJet al. Open-label, sham-control­led trial of anendoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc 2010; 71(6): 976– 982. doi: 10.1016/ j.gie.2009.11.051.

14. Sandler BJ, Rumbaut R, Swain CP et al. Human experience with an endoluminal, endoscopic, gastrojejunal bypass sleeve. Surg Endosc 2011; 25(9): 3028– 3033. doi: 10.1007/ s00464-011-1665-6.

15. Rubino F, Schauer PR, Kaplan LM et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. An­nu Rev Med 2010; 61: 393– 411. doi: 10.1146/ an­nurev.med.051308.105148.

16. Cohen R, le Roux CW, Papamargaritis Det al. Role of proximal gut exclusion fromfood on glucose homeostasis in patients with type 2 diabetes. Diabet Med 2013;30(12): 1482– 1486. doi: 10.1111/ dme. 12268.

17. Cum­mings DE. Endocrine mechanisms mediat­ing remis­sion of diabetes after gastric bypass surgery. Int J Obes (Lond) 2009; 33 (Suppl 1): S33– S40. doi: 10.1038/  ijo.2009.15.

18. Sjöström L, Lindroos AK, Peltonen M at al. Lifestyle, diabetes and cardiovascular risc factors 10 years after bariatric surgery. N Engl J Med 2004, 351(26): 2683– 2693.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Article was published in

Gastroenterology and Hepatology

Issue 6

2016 Issue 6

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#