EndoBarrier treatment for longstanding type 2 diabetes and obesity: outcomes one year after EndoBarrier in 90 consecutively treated patients

Abstract

AbstractAims: EndoBarrier is a 60cm duodenal–jejunal bypass liner endoscopically implanted for up to one year and designed to mimic the by‐pass part of Roux‐en‐Y bariatric surgery. We aimed to assess the safety and efficacy of EndoBarrier in patients with suboptimally‐controlled diabesity.Methods: Between July 2013 and November 2017 we implanted 90 EndoBarriers in a single centre with all removed by November 2018. Outcomes were monitored in a registry.Results: All 90 patients have completed one‐year post EndoBarrier removal and, of these, 71/90 (79%) – age 51.3 ± 8.6 years, 46% male, 52% White ethnicity, diabetes duration 13.0 (7.0–17.0) years, 59% insulin‐treated, BMI 41.1 ± 6.5kg/m2) – attended follow‐up and 19/90 (21%) did not attend follow‐up. During EndoBarrier implantation, mean ± SD HbA1c fell by 19.5 ± 18.4mmol/mol from 78.1 ± 18.9 to 58.6 ± 13.6mmol/mol (p < 0.001), weight by 15.9 ± 8.6kg from 118.4 ± 27.0 to 102.4 ± 27.7kg (p < 0.001), systolic BP from 139.0 ± 15.0mmHg to 126.6 ± 17.6mmHg (p < 0.001), cholesterol from 4.8 ± 1.2 to 4.0 ± 1.0mmol/L (p < 0.001), and serum alanine‐aminotransferase (marker of liver fat) from 31.0 ± 16.5 to 19.8 ± 11.5U/L (p < 0.001). Median (IQR) total daily insulin dose reduced from 98 (53–163) to 30 (0–63) units (p < 0.001). Eleven of 42 (26.2%) insulin treated patients discontinued insulin. One year post‐EndoBarrier 32/71 (45%) demonstrated fully‐sustained improvement, 25/71 (35%) partially‐sustained improvement and 14/71 (20%) reverted to baseline. Of those deteriorating, 10/14 (71%) had depression and/or bereavement. Thirteen of 90 (14%) patients required early EndoBarrier removal: five for gastrointestinal haemorrhage, two for liver abscess, one for non‐hepatic intra‐abdominal abscess, and five for gastrointestinal symptoms. All made a full recovery.Conclusion: Our data demonstrate EndoBarrier as highly effective in patients with refractory diabesity, with maintenance of significant improvement one year after removal in 80% of cases. As it requires only an endoscopic procedure, EndoBarrier treatment is relatively simple and non‐invasive and it deserves further investigation. Copyright © 2022 John Wiley & Sons.