Duodenal-jejunal Bypass Sleeve Research Articles

Application of Endoscopic Duodenal-Jejunal Bypass Sleeve in the Treatment of Obesity Combined with Type 2 Diabetes Mellitus

Application of Endoscopic Duodenal-Jejunal Bypass Sleeve in the Treatment of Obesity Combined with Type 2 Diabetes Mellitus

Induction of Meal-related Symptoms as a Novel Mechanism of Action of the Duodenal-Jejunal Bypass Sleeve.

Treatment with a duodenal-jejunal bypass sleeve (DJBS) induces clinically significant weight loss, but little is known about the mechanisms of action of this device. The aim of this study was to characterize the mechanisms of action of the DJBS and determine the durability of weight loss and metabolic improvements. We studied a cohort of 19 subjects with severe obesity and type 2 diabetes (baseline body mass index: 43.7±5.3 kg/m). Anthropometry, body composition, blood pressure, biochemical measures, and dietary intake were monitored for 48 weeks after DJBS implantation, and then for 1 year after device removal. Gastric emptying and triglyceride absorption were measured at baseline, 8 weeks after implant, and within 3 weeks of device explant. Visceral sensory function was assessed at baseline, 4 weeks after implant, and within 3 weeks after explant. Significant weight loss (P<0.01) occurred following DJBS placement, with a mean weight reduction of 17.0±6.5% at 48 weeks. The symptom burden following a standardized nutrient challenge was increased after DJBS implantation (P<0.05), returning to baseline after DJBS removal. Neither gastric emptying nor triglyceride absorption changed with the device in situ. A significant reduction in energy intake was observed [baseline: 7703±2978 kJ (1841±712 kcal), 24 weeks: 4824±2259 kJ (1153±540 kcal), and 48 weeks: 4474±1468 kJ (1069±351 kcal)]. After 1 year, anthropometry remained significantly improved, but there was no durable impact on metabolic outcomes. DJBS treatment resulted in substantial weight loss. Weight loss is related to reduced caloric intake, which seems linked to an augmented upper gastrointestinal symptom response, but not altered fat absorption.

Tu1912 – Weight Loss and Metabolic Improvements One Year After Treatment with a Duodenal-Jejunal Bypass Sleeve (Endobarrier®)

Tu1912 – Weight Loss and Metabolic Improvements One Year After Treatment with a Duodenal-Jejunal Bypass Sleeve (Endobarrier®)

Metabolic and nutrition-related effects of a duodenal-jejunal bypass sleeve in patients with obesity and Type II diabetes: Preliminary results of a pilot study

Metabolic and nutrition-related effects of a duodenal-jejunal bypass sleeve in patients with obesity and Type II diabetes: Preliminary results of a pilot study

Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study

BackgroundObesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk, based on age, body mass index, sex and other comorbidities such as hypertension and history of pulmonary embolism. High-risk patients not only have a higher mortality but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (Endobarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness.The aim of this study was to assess if pre-operative insertion of endobarrier in high-risk patients can decrease morbidity and length of stay after bariatric surgery.Materials and MethodsBetween 2012 and 2014, a cohort of 11 high-risk patients had an Endobarrier inserted (E&BS group) for 1 year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS group) during same duration. The two groups were matched for age, gender, body mass index, comorbidities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, intensive therapy unit (ITU) stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL).ResultsPatient characteristics and OS-MRS were similar in both groups (match tolerance 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in the E&BS group (p < 0.05) with significant likelihood of planned ITU admissions in the PBS group (p < 0.05).ConclusionEndobarrier could be considered as a pre bariatric surgical intervention in high-risk patients. It may result in improved post-operative outcomes in high-risk bariatric patients.

Su1977 - Characterization of the Mucosal- and Device-Associated Microbiota Following 48 Weeks Treatment with a Duodenal-Jejunal Bypass Sleeve (Endobarrier®)

Su1977 - Characterization of the Mucosal- and Device-Associated Microbiota Following 48 Weeks Treatment with a Duodenal-Jejunal Bypass Sleeve (Endobarrier®)

A randomised controlled trial of a duodenal-jejunal bypass sleeve device (EndoBarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes mellitus

IntroductionThe prevalence of obesity and obesity-related diseases, including type 2 diabetes mellitus (T2DM), is increasing. Exclusion of the foregut, as occurs in Roux-en-Y gastric bypass, has a key role in...

Novel Nonsurgical Endoscopic Approaches for the Treatment of Obesity.

Globally, obesity is a leading cause of preventable death and is associated with >60 comorbid medical conditions, including 10 types of cancer that are strongly associated with body mass index. There are a number of traditional obesity treatments-for example, lifestyle management (eg, decreased caloric intake and increased expenditure), pharmacotherapy, and bariatric surgery. Recently, endoscopic approaches have emerged as a viable alternative for weight loss. Endoscopically placed intragastric balloons were introduced in the early 1980s for the treatment of medically complicated obesity but, unfortunately, had high rates of complications, such as premature deflation leading to obstruction. Despite these shortcomings, these devices have experienced a renewal, with a second generation of improved devices being approved for clinical use in 2015. In addition to the intragastric balloons, there are a number of other endoscopic approaches to weight loss that are either Food and Drug Administration approved or undergoing evaluation (aspiration therapy, duodenal jejunal bypass sleeve). The current review examines the literature available and discusses the practical clinical considerations involved.

Su2044 - Improvements of Liver and Glycaemic Parameters after Duodenal-Jejunal Bypass Sleeve (DJBS) Insertion

Su2044 - Improvements of Liver and Glycaemic Parameters after Duodenal-Jejunal Bypass Sleeve (DJBS) Insertion

Su2042 - Augmentation of Meal-Related Symptoms following Placement of Duodenal-Jejunal Bypass Sleeve is a Potential Mechanism of Action Inducing Weight Loss

Su2042 - Augmentation of Meal-Related Symptoms following Placement of Duodenal-Jejunal Bypass Sleeve is a Potential Mechanism of Action Inducing Weight Loss

The impact of EndoBarrier gastrointestinal liner in obese patients with normal glucose tolerance and in patients with type 2 diabetes.

The duodenal-jejunal bypass sleeve ((DJBS) or EndoBarrier Gastrointestinal Liner) induces weight loss in obese subjects and may improve glucose homeostasis in patients with type 2 diabetes (T2D). To explore the underlying mechanisms, we evaluated postprandial physiology including glucose metabolism, gut hormone secretion, gallbladder emptying, appetite and food intake in patients undergoing DJBS treatment. A total of 10 normal glucose-tolerant (NGT) obese subjects and 9 age-, body weight- and body mass index-matched metformin-treated T2D patients underwent a liquid mixed meal test and a subsequent ad libitum meal test before implantation with DJBS and 1 week (1w) and 26 weeks (26w) after implantation. At 26w, both groups had achieved a weight loss of 6 to 7 kg. Postprandial glucagon-like peptide-1 (GLP-1) and peptide YY responses increased at 1w and 26w, but only in T2D subjects. In contrast, glucose-dependent insulinotropic polypeptide responses were reduced only by DJBS in the NGT group. Postprandial glucose, insulin, C-peptide, glucagon, cholecystokinin and gastrin responses were unaffected by DJBS in both groups. Satiety and fullness sensations were stronger and food intake was reduced at 1w in NGT subjects; no changes in appetite measures or food intake were observed in the T2D group. No effect of DJBS on postprandial gallbladder emptying was observed, and gastric emptying was not delayed. DJBS-induced weight loss was associated with only marginal changes in postprandial physiology, which may explain the absence of effect on postprandial glucose metabolism.

Surgical cure for type 2 diabetes by foregut or hindgut operations: a myth or reality? A systematic review.

Bariatric surgery results in remission of type 2 diabetes mellitus in a significant proportion of patients. Animal research has proposed the foregut and hindgut hypotheses as possible mechanisms of remission of T2DM independent of weight loss. These hypotheses have formed the basis of investigational procedures designed to treat T2DM in non-obese (in addition to obese) patients. The aim of this study was to review the procedures that utilise the foregut and hindgut hypotheses to treat T2DM in humans. A systematic review was conducted to identify the investigational procedures performed in humans that are based on the foregut and hindgut hypotheses and then to assess their outcomes. Twenty-four studies reported novel procedures to treat T2DM in humans; only ten utilised glycated haemoglobin A1c (HbA1c) in their definition of remission. Reported remission rates were 20-40% for duodenal-jejunal bypass (DJB), 73-93% for duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG), 62.5-100% for duodenal-jejunal bypass sleeve (DJBS) and 47-95.7% for ileal interposition with sleeve gastrectomy (II-SG). When using a predetermined level of HbA1c to define remission, the remission rates were lower (27, 63, 0 and 65%) for DJB, DJB-SG, DJBS and II-SG. The outcomes of the foregut- and hindgut-based procedures are not better than the outcomes of just one of their components, namely sleeve gastrectomy. The complexity of these procedures in addition to their comparable outcomes to a simpler operation questions their utility.

Su1976 Endoscopic Treatment of Obesity With a Duodenal-Jejunal Bypass Sleeve: Does Impairment of Fat Absorption Explain Weight Loss?

Su1976 Endoscopic Treatment of Obesity With a Duodenal-Jejunal Bypass Sleeve: Does Impairment of Fat Absorption Explain Weight Loss?

1138 A Pre-Clinical Animal Study of Combined Intragastric Balloon and Duodenal-Jejunal Bypass Sleeve for Obesity and Metabolic Disease

INTRODUCTION Endoscopic bariatric and metabolic therapies can potentially reproduce similar gastric and small intestinal anatomic and physiologic manipulations as Roux-en-Y gastric bypass. This proof of concept animal study was aimed to assess the feasibility, safety, efficacy, and impact on gastrointestinal physiology of combined intragastric balloons (IGB) and duodenal-jejunal bypass liner (DJBL) for the treatment of obesity. METHODS Five Ossabaw pigs were fed a high-calorie diet to develop obesity and were randomly assigned to receive IGB or DJBL in sequence. The weight gain rate was calculated. Fasting and postprandial blood samples were drawn before any intervention (serving as the baseline group) and 1 month after second device insertion (serving as the combination group) to measure gut neurohormonal changes and metabolic parameters. RESULTS Four pigs successfully received a sequential device insertion. One pig developed duodenal sleeve prolapse that was spontaneously resolved. One pig was early terminated because of developing a central line infection. The rate of weight gain in the combination group (0.63 ± 1.3 kg/wk) was significantly lower than the baseline group (1.96 ± 2.17 kg/wk) and numerically lower than after insertion of the IGB (1.00 ± 1.40 kg/wk) or the DJBL (0.75 ± 2.27 kg/wk) alone. A trend of higher postprandial glucagon-like peptide-1 was observed in the combination group compared with the baseline group. DISCUSSION A combination of IGB and DJBL is feasible and well tolerated. A strategy of sequential use of these devices might offer a synergistic approach that can enhance weight loss and metabolic outcomes.

Hepatic abscess as a complication of duodenal-jejunal bypass sleeve system and review of the literature

Hepatic abscess as a complication of duodenal-jejunal bypass sleeve system and review of the literature Umberto Maggi, M.D., Ph.D.*, Andrea Formiga, M.D., Roberto Lauro, M.D. Hepatobiliary and Liver Transplant Unit, IRCCS Foundation, Policlinico Major Hospital, Milan, Italy General Surgery and Digestive Endoscopy Unit, Casa di Cura Capitanio/Auxologic Institute, via Mercalli 28/30, Milan, Italy Received January 29, 2016; received in revised form February 18, 2016; accepted February 18, 2016

Effect of the EndoBarrier Gastrointestinal Liner on obesity and type 2 diabetes: a systematic review and meta‐analysis

Compared with bariatric surgery, less invasive and reversible techniques to counteract obesity and type 2 diabetes (T2D) have been developed, including the EndoBarrier Gastrointestinal Liner [duodenal-jejunal bypass sleeve (DJBS)]. We conducted a systematic review and meta-analyses of eligible trials to evaluate the efficacy and safety of the DJBS. Five randomized controlled trials (RCTs; 235 subjects) and 10 observational studies (211 subjects) were included. The risk of bias was evaluated as high in all studies. The mean body mass index ranged from 30 to 49.2 kg/m(2) and 10-100% of the subjects had T2D. Meta-analysis showed that the DJBS was associated with significant mean differences in body weight and excess weight loss of -5.1 kg [95% confidence interval (CI) -7.3, -3.0; four trials; n = 151; I(2) = 37%] and 12.6% (95% CI 9.0, 16.2; four trials; n = 166; I(2) = 24%), respectively, compared with diet modification. The mean differences in glycated haemoglobin (-0.9%; 95% CI -1.8, 0.0) and fasting plasma glucose (-3.7 mM; 95% CI -8.2, 0.8) among subjects with T2D did not reach statistical significance. Adverse events consisted mainly of abdominal pain, nausea and vomiting. No deaths occurred. Future high-quality long-term RCTs are needed to further assess efficacy and safety.

Relief of diabetes by duodenal-jejunal bypass sleeve implantation in the high-fat diet and streptozotocin-induced diabetic rat model is associated with an increase in GLP-1 levels and the number of GLP-1-positive cells.

A recently invented duodenal-jejunal bypass sleeve (DJBS) implanted in the duodenum and proximal jejunum has exhibited good glycemic control in diabetes mellitus. However, the specific mechanism by which DJBS placement induces the remission of diabetes is not well known. Previous studies have indicated that changes in the pattern of gut hormone secretion may play a role. The aim of the present study was to explore the role of intestinal L cells and the production of glucagon-like peptide-1 (GLP-1) by these cells in DJBS implantation-induced glycemic control in diabetic rats. A DJBS was placed in the proximal small intestine of rats with diabetes induced by a high-fat diet and low-dose streptozotocin (STZ), and the effects of the DJBS on the remission of diabetes and the GLP-1 levels of plasma and intestinal tissues were investigated 12 weeks after DJBS placement. The number of intestinal GLP-1 positive cells was also counted. When the DJBS had been in place for 12 weeks, the plasma glucose level of the DJBS-implanted rats decreased significantly from 23.33±1.56 mmol/l prior to surgery to 7.70±0.84 mmol/l and the diabetes mellitus was relieved completely; however, diabetic control rats and diabetic rats subjected to sham surgery did not show any improvement. Parallel with the remission of diabetes, the plasma and distal ileum GLP-1 levels of rats in the DJBS implantation group were also higher than those of rats in the diabetic control and sham surgery groups. The number of GLP-1-positive cells in the distal ileum was also higher in the DJBS implantation group than in the diabetic control and sham surgery groups (31.0±2.6 vs. 23.5±4.4 vs. 23.0±3.2 respectively; P<0.01). DJBS implantation effectively led to the remission of diabetes in rats with diabetes induced by a high-fat diet and low-dose STZ when implanted for 12 weeks. The remission of diabetes may be associated with the increase in the number of L cells and elevation of GLP-1 levels induced by DJBS implantation.

Tu1468 A Pre-Clinical Animal Study Evaluating the Feasibility and Efficacy of a Combined Intragastric Balloon and Duodenal-Jejunal Bypass Sleeve for the Endoscopic Treatment of Obesity

Tu1468 A Pre-Clinical Animal Study Evaluating the Feasibility and Efficacy of a Combined Intragastric Balloon and Duodenal-Jejunal Bypass Sleeve for the Endoscopic Treatment of Obesity

Effect of the EndoBarrier Gastrointestinal Liner on obesity and type 2 diabetes: protocol for systematic review and meta-analysis of clinical studies

IntroductionObese patients with type 2 diabetes undergoing bariatric surgery experience significant and lasting weight loss and improved glycaemic control. However, bariatric surgical procedures such as Roux-en-Y gastric bypass are irreversible...

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

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.