Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control

Abstract

The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariat­ric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article compre­hensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern ex­ists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongo­ing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to sup­port its routine use in clinical practice.

Bacteroides and NAFLD: pathophysiology and therapy

“…In recent years, researchers have proposed new treatments for NAFLD, such as bariatric surgery, endoscopic therapy, glucagon-like peptide 1 (GLP-1) receptor agonists, statins, vitamin E and fecal microbiota transplantation ( Smits et al, 2013 ; Nguyen and Varela, 2017 ; Hadi et al, 2018 ; Azemawah et al, 2019 ; Doumas et al, 2019 ; Lefere et al, 2021 ; Mandour et al, 2022 ; Geerts and Lefere, 2023 ; Lee and Kim, 2023 ; Igi et al, 2024 ). Compared to these treatments, Bacteroides , a single-strain probiotic supplementation, is not only safe but also regulates the gut microbiota and treats the root cause of NAFLD ( Carpi et al, 2022 ).…”