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

Czech version

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 HbA_1c 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 (HbA_1c 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

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