Long-term effects of proximal small bowel exclusion by duodenal-jejunal bypass liner on weight reduction and glycemic control in diabetic patients

Deutsch, Liat; Haim, Limor Ben; Sofer, Yael; Gluck, Nathan; Santo, Erwin; Fishman, Sigal

doi:10.1016/j.soard.2018.07.022

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…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%

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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

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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.

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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

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“…Several studies reported quite similar outcomes up to 6–12 months after the device removal. Forner et al 17 found that about 74% of the patients regained one‐third of the weight at 6 months after explantation and Deutsch et al 9 reported weight regain of 50% of the weight loss at 12 months after explantation. Betzel et al 8 observed only patients with type 2 diabetes and found that %TBWL decreased from 12.6% to 7.4% at 12 months after explantation.…”

Section: Discussionmentioning

confidence: 99%

“…Initially designed for the treatment of type 2 diabetes, 6 previous data from several studies have shown its efficacy for improvement in glycaemic control as well as weight loss 7 mostly during the duration of the treatment of DJBL for 6–12 months. Only few studies have explored the medium‐ and long‐term follow‐up (in particular regarding weight regain) after the explantation of the device 8–11 . The aim of this study is to describe the short‐term weight loss with DJBL as well as long‐term weight regain after the device removal for up to 5 years of follow‐up.…”

Section: Introductionmentioning

confidence: 99%

“…Only few studies have explored the medium‐ and long‐term follow‐up (in particular regarding weight regain) after the explantation of the device. 8 , 9 , 10 , 11 The aim of this study is to describe the short‐term weight loss with DJBL as well as long‐term weight regain after the device removal for up to 5 years of follow‐up. Furthermore, the intention was to identify possible predictors of successful weight loss/limited weight regain.…”

Section: Introductionmentioning

confidence: 99%

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Sustained weight loss after duodenal–jejunal bypass liner treatment in patients with body mass index below, but not above 35 kg/m²: A retrospective cohort study

et al. 2022

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Previous data from short term studies have shown an efficacy of the duodenal-jejunal bypass liner (DJBL) for weight loss. However, less data is available regarding weight change after device removal and possible predictors for weight loss. This is a retrospective chart review of all patients who had DJBL inserted at the University Hospital Zurich between December 2012 and June 2015. A total of 27 patients had DJBL insertion. The median BMI at baseline was 38.5 (34.0-42.2) kg/m 2 . In the 24 patients with DJBL treatment >3 months (failed implantation or early removal due to side effects in 3 patients), the mean duration of implantation was 42.9 ± 13.1 weeks. During the treatment, the mean total body weight loss (%TBWL) was 15.0 ± 8.3%. Fifteen patients had long-term follow-up data available (mean duration of follow-up 4.0 ± 0.9 years). The mean weight change was 12.7 ± 12.8 kg, corresponding with a mean % weight regain of 13.3 ± 13.3%. Five patients (33.3%) subsequently underwent bariatric surgery. In patients with class I obesity (BMI <35 kg/m 2 at baseline), 4 out of 6 (66.7%) had a stable weight or only a weight regain <7%.In contrast, no patient with BMI >35 kg/m 2 at baseline was able to keep weight regain below 7%. DJBL is an effective treatment for obesity, but substantial weight regain occurs during long-term follow up after the device removal, in particular in patients with BMI > 35 kg/m 2 .

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2024

Malabsorptive Surgeries

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Long-term effects of proximal small bowel exclusion by duodenal-jejunal bypass liner on weight reduction and glycemic control in diabetic patients

Cited by 10 publications

References 15 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?

Sustained weight loss after duodenal–jejunal bypass liner treatment in patients with body mass index below, but not above 35 kg/m²: A retrospective cohort study

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Long-term effects of proximal small bowel exclusion by duodenal-jejunal bypass liner on weight reduction and glycemic control in diabetic patients

Cited by 10 publications

References 15 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?

Sustained weight loss after duodenal–jejunal bypass liner treatment in patients with body mass index below, but not above 35 kg/m2: A retrospective cohort study

Endobarrier

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Sustained weight loss after duodenal–jejunal bypass liner treatment in patients with body mass index below, but not above 35 kg/m²: A retrospective cohort study