The Duodenal-Jejunal Bypass Sleeve (EndoBarrier Gastrointestinal Liner) for Weight Loss and Treatment of Type II Diabetes

Abstract

Obesity has reached epidemic proportions in the western world. Reaching epidemic status on a global scale is inevitable as more than 300 million people worldwide are now obese, defined by a Body Mass Index (BMI) greater than 30 kg/m2 [1]. This has resulted in a recent boom in novel techniques for treating obesity. It is widely acknowledged that conservative interventions such as dietary and behavioural modification as well as pharmacological therapy have less than favourable long-term outcomes [2, 3]. Indeed, surgical intervention is now the most effective modality with which to treat severe obesity. Patient criteria for selection is controversial, but under the 1991 National Institutes of Health (NIH) guidelines, surgery is an option for well-informed and motivated patients who have a BMI of at least 40 or a BMI of at least 35 with serious co-morbid conditions [4]. However, surgical interventions, despite producing sustainable weight loss, have been shadowed by relatively high re-operative rates and variable long-term weight loss results. Therefore, there have been numerous strategies employed in an effort to improve long-term surgical outcomes. One of these is to induce pre-operative weight loss, which has been shown to positively correlate with long-term post-operative weight loss [5]. Pre-operative weight loss by low energy diet has consistently been proven ineffective and so there has been a new focus on minimally invasive techniques to achieve the desired result. The duodenal-jejunal bypass sleeve is one such technology that theoretically can be used as a method of inducing weight loss. Weight loss in the setting of Type II diabetes mellitus can prove difficult to manage. Diet and lifestyle changes are important, but as with bariatric results outside of the diabetes arena, they are often not enough. Pharmacological interventions are again not effective and are plagued with side effects. Surgical procedures such as laparoscopic banding, gastric bypass and sleeve gastrectomy are effective. However, patients fear surgery and the permanence of this option. There is an alternative that has recently surged to the forefront of our arena. With promising trial results in the settings of isolated weight loss and in type II diabetes, as well as having a less invasive nature when compared with surgery, more patients and bariatric specialists are turning to the EndoBarrier.