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

Abstract

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.

EndoBarrier™ Implantation Rapidly Improves Insulin Sensitivity in Obese Individuals with Type 2 Diabetes Mellitus

“…While a number of studies [ 7 , 9 , 10 ] have reported significant improvements in glucose parameters observed with the duodenal-jejunal bypass liner, reaching a maximum at 36 weeks after implantation, we were able to demonstrate a significant and sustained effect of the device on insulin sensitivity already at 4 weeks after the implantation of the device. HbA1c was reduced but this did not reach statistical significance.…”

“…The Endobarrier™ can be placed endoscopically and provides a minimally invasive, reversible option which does not change the anatomy of the digestive tract permanently as is the case with bariatric surgery. It can be used for high-risk patients as a pre-bariatric surgical intervention to lose weight before the surgery [ 10 ]. However, the Endobarrier™ device causes gastrointestinal side effects, which occurred in 40% of our participants.…”

Food addiction and preoperative weight loss achievement in patients seeking bariatric surgery

“…Although it remains controversial in the literature, a preoperative WL prior to BS is frequently recommended (Gerber, Anderin, & Thorell, ), even though current guidelines do not consider it as mandatory (Bray et al, ; Mechanick et al, ). The procedures will vary from integral lifestyle intervention with hypocaloric diet and exercise (Gerber et al, ) to laparoscopic bridge interventions, such as Intragastric Balloon or Endobarrier, suggested by some authors (Quiroz, Peniche, Cuevas, & Farell, ; Younus, Chakravartty, Sarma, & Patel, ). The rationale behind the achievement of WL prior to BS (generally 5–10% of weight excess) is that it may lead to an improvement in cardiovascular risk factors (Veronese et al, ), more optimal laparoscopic approach and operating time (Alami et al, ; Edholm et al, ), a reduction in postsurgical complications (Anderin, Gustafsson, Heijbel, & Thorell, ; Giordano & Victorzon, ), and more WL after BS (Alger‐Mayer, Polimeni, & Malone, ; Alvarado et al, ; Gerber, Anderin, Gustafsson, & Thorell, ; Steinbeisser, McCracken, & Kharbutli, ).…”

Bariatric Surgery–How Much Malabsorption Do We Need?—A Review of Various Limb Lengths in Different Gastric Bypass Procedures

“…The most common bariatric procedure, Sleeve Gastrectomy (SG), as well as the formerly very common Gastric Banding (GB), will not be discussed as both procedures are based on the principle of restriction instead of malabsorption. Endoscopic malabsorptive procedures, such as the Endobarrier ® , GI-window ® , among others, were not included either due to the small number of patients or the short lengths of follow-up in most studies available today [ 11 ].…”