The duodenal-jejunal bypass liner (EndoBarrier®) for the treatment of type 2 diabetes mellitus in obese patients – efficacy and factors predicting optimal effects
Marek Beneš1, Tomáš Hucl1, Pavel Drastich1, Radan Keil2, Zuzana Vlasáková3, Tereza Pelikánová3, Petra Kaválková4, Miloš Mráz5, Zdeňka Lacinová5,6, Martin Haluzík4,6, Julius Špičák1
1 Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
2 Interní klinika 2. LF UK a FN Motol, Praha
3 Laboratoř klinické patofyziologie, Centrum diabetologie, IKEM, Praha
4 Ústav lékařské biochemie a laboratorní diagnostiky, 1. LF UK a VFN v Praze
5 III. interní klinika 1. LF UK a VFN v Praze
6 Endokrinologický ústav, Praha
Summary: 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-Y gastric 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/sqmand a mean HbA1c 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 (HbA1c, 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.
KeywordsEndoBarrier, bariatric endoscopy, metabolic syndrome
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