Comparative efficacy and safety of the duodenal‐jejunal bypass liner in obese patients with type 2 diabetes mellitus: A case control study

Laubner, Katharina; Riedel, Nina; Fink, Katharina; Holl, Reinhard W.; Welp, Reinhard; Kempe, Hans‐Peter; Lautenbach, Anne; Schlensak, Matthias; Stengel, R; Eberl, Thomas; Dederichs, Frank; Schwacha, H; Seufert, Jochen; Aberle, Jens

doi:10.1111/dom.13300

Cited by 24 publications

(40 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall, 23 studies met the eligibility criteria from the screened and assessed full-text publications. Due to overlap, 6 publications were excluded, leaving 17 publications in the final analysis (11 for DJBL and 6 for PPBS) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Details are listed in the flow chart presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

Balint¹,

Csaszar

Somodi

et al. 2021

Langenbecks Arch Surg

View full text Add to dashboard Cite

Purpose Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. Methods A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. Results A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): −0.03 and confidence interval (CI): −0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01–0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: −0.03, CI: −0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74–1.59 for BMI changes). Conclusion Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors’ hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Favourable weight loss outcomes and metabolic control are expected by creating a physical barrier between the mucosa of the upper small intestine and the ingested food. Longitudinal temporal data on efficacy is lacking, and published complication rates are controversial [13][14][15][16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

Balint¹,

Csaszar

Somodi

et al. 2021

Langenbecks Arch Surg

View full text Add to dashboard Cite

show abstract

“…It is held in place by a nitinol anchor, such that food passes through it without coming into contact with the small intestine, thereby mimicking the bypass part of Roux-en-Y bariatric surgery. [1][2][3] The endoscopic insertion and removal of EndoBarrier are day case procedures, performed in less than an hour under general anaesthesia. This form of reversible bariatric procedure has been shown to reduce weight and improve glycaemic control in people with diabetes and obesity.…”

Section: Introductionmentioning

confidence: 99%

“…This form of reversible bariatric procedure has been shown to reduce weight and improve glycaemic control in people with diabetes and obesity. [2][3][4][5][6][7][8] As previously described in detail elsewhere, 8 we established in 2014 a National Health Service (NHS) service providing EndoBarrier treatment to people with long-standing poorly controlled type 2 diabetes and obesity which continued to be a problem despite all attempts to improve the situation with diet and lifestyle mea-sures as well as available diabetes medications. We treated 62 people with diabetes with EndoBarrier in this service.…”

Section: Introductionmentioning

confidence: 99%

The United Kingdom’s first NHS EndoBarrier service for long-standing poorly controlled type 2 diabetes and obesity: outcomes one year after EndoBarrier removal

Ryder

Yadagiri²,

Burbridge³

et al. 2021

Br J Diabetes

View full text Add to dashboard Cite

Aims: EndoBarrier is a 60 cm duodenal–jejunal bypass liner endoscopically implanted for up to one year. It mimics the bypass part of Roux-en-Y bariatric surgery and reduces weight and HbA1c while it is in situ. We aimed to assess the extent to which these improvements are sustained in people with diabetes in the year following removal.Methods: Between October 2014 and November 2017 we implanted 62 EndoBarriers in an NHS service with all removed by November 2018. Outcomes were monitored in a registry.Results: By November 2019, 46/62 (72%) (mean±SD age 51.5±7.7 years, 52% male, 54.3% white ethnicity, median (IQR) diabetes duration 14.5 (8–20) years, 67.4% insulin-treated and mean±SD body mass index (BMI) 41.6±7.1 kg/m2) had attended and 16/62 (28%) did not attend their one-year post-EndoBarrier follow-up appointment. In those who attended, during EndoBarrier implantation mean±SD HbA1c fell by 21.1±19.6 mmol/mol from 77.1±20.0 to 56.0±11.2 mmol/mol (p<0.001) (by 1.9±1.8% from 9.2±1.8% to 7.3±1.0% (p<0.001)), weight fell by 17.2±8.8 kg from 121.9±29.4 kg to 104.7±30.1 kg (p<0.001), BMI fell from 41.6±7.5 to 35.5±7.5 kg/m2 (p<0.001), systolic blood pressure from 139.0±14.0 to 126.0±14.6 mmHg (p<0.001) and serum alanine aminotransferase from 30.0±16.9 to 18.8±11.0 U/L (p<0.001). Median (IQR) total daily insulin dose reduced from 104 (54–162) to 30 (0–62) units (n=31, p<0.001); 10/31 (32%) insulin-treated people with diabetes were able to discontinue insulin. One year post-EndoBarrier, 18/46 (39%) demonstrated fully sustained improvement, 18/46 (39%) partially sustained improvement and 10/46 (22%) reverted to baseline. Of those deteriorating, 9/10 (90%) had depression and/or bereavement; they also had less fall in weight and HbA1c during EndoBarrier treatment. In the 16/62 (28%) who did not attend follow-up, reasons for non-attendance were too far to travel (25%), need to take time off work (6.3%), severe depression (6.3%) and death (6.3%). In 56.3% of cases no reason was given.Conclusion: Our data demonstrate that EndoBarrier is highly effective in people with long-standing poorly controlled type 2 diabetes and obesity, with maintenance of significant improvement one year after removal in 78% of cases for whom data were available. As an endoscopic procedure it is relatively simple and non-invasive and it deserves further investigation.

show abstract

“…Surgery was required in 8 patients, but no deaths were reported. Despite these risks, Laubner et al ( 70 ) showed possible positive risk-benefit ratio in favor of DJBL for T2DM treatment.…”

Section: Introductionmentioning

confidence: 99%

Bariatric and Metabolic Endoscopy: A New Paradigm

Telese

Sehgal

Magee

et al. 2021

Clin Transl Gastroenterol

View full text Add to dashboard Cite

The prevalence of obesity, type 2 diabetes mellitus, and metabolic syndromes is increasing globally. Minimally invasive metabobariatric (MB) endoscopic therapies are adjunct treatments that can potentially bridge the gap between surgical interventions and medical therapy. A growing number of MB techniques are becoming available, allowing for more personalized and patient-targeted treatment options for specific disease states. MB techniques are less invasive than surgery and can precisely target different parts of the gastrointestinal tract that may be responsible for the pathophysiology of obesity and metabolic syndromes such as type 2 diabetes mellitus. These alternatives should be selected on an individualized patient basis to balance the expected clinical outcomes and desired anatomical targets with the level of invasiveness and degree of acceptable risk. Each MB intervention presents great flexibility allowing for a tailored intervention and different levels of patient engagement. Patient awareness and motivation are essential to avoid therapy withdrawal and failure. Differences between MB procedures in terms of weight loss and metabolic benefit will be discussed in this review, along with the insights on clinical decision-making processes to evaluate the potential of further evolution and growth of bariatric and metabolic endoscopy.

show abstract

Comparative efficacy and safety of the duodenal‐jejunal bypass liner in obese patients with type 2 diabetes mellitus: A case control study

Abstract: This study provides the largest, so far, hypothesis-generating evidence for a putative positive risk/benefit ratio for treatment of obese patients with type 2 diabetes mellitus with the DJBL as an alternative treatment option for this patient population.

Cited by 24 publications

References 29 publications

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

The United Kingdom’s first NHS EndoBarrier service for long-standing poorly controlled type 2 diabetes and obesity: outcomes one year after EndoBarrier removal

Bariatric and Metabolic Endoscopy: A New Paradigm

Contact Info

Product

Resources

About