Une méthode non invasive de traitement du diabète: l’endo-sleeve

Abstract

While bariatric surgery induces long-term weight loss, and a reduction of type 2 diabetes mellitus in morbidly obese patients, less invasive methods are being investigated. The duodenal-jejunal bypass sleeve (DJBS), or EndoBarrier Gastrointestinal Liner, is such a tool and mimicks a duodenal-jejunal bypass. It has an anchor, to reversibly affix the device to the wall of the duodenum, and an impermeable fluoropolymer sleeve extending 60 cm into the small bowel. Because of the theoretical impact on diabetes mellitus caused by the foregut exclusion, the DJBS has gained interest. Thirty patients were included in a prospective randomized trial and compared to 11 control patients. Four devices were placed, 4 were withdrawn because of obstruction (1), migration (2), or unexplained abdominal pain (1). Weight loss after 12 weeks was respectively, 19 and 6.9%. Eight patients had diabetes in the device group: 6 were improved and 1 was cured. Mean fasting glucose levels before the device placement and after 12 weeks were 11.1 and 9.3 mmol/l. HbA1c levels decreased in the same period from 8.8 to 7.7%. The DJBS is safe and feasible, and has a significant positive effect on glucose homeostasis in diabetic patients. It would be preferable to a more invasive procedure. More research has to be performed focusing on diabetes and long-term results.