Endocrine effects of duodenal–jejunal exclusion in obese patients with type 2 diabetes mellitus

Abstract

Duodenal-jejunal bypass liner (DJBL) is an endoscopically implantable device designed to noninvasively mimic the effects of gastrointestinal bypass operations by excluding the duodenum and proximal jejunum from the contact with ingested food. The aim of our study was to assess the influence of DJBL on anthropometric parameters, glucose regulation, metabolic and hormonal profile in obese patients with type 2 diabetes mellitus (T2DM) and to characterize both the magnitude and the possible mechanisms of its effect. Thirty obese patients with poorly controlled T2DM underwent the implantation of DJBL and were assessed before and 1, 6 and 10 months after the implantation, and 3 months after the removal of DJBL. The implantation decreased body weight, and improved lipid levels and glucose regulation along with reduced glycemic variability. Serum concentrations of fibroblast growth factor 19 (FGF19) and bile acids markedly increased together with a tendency to restoration of postprandial peak of GLP1. White blood cell count slightly increased and red blood cell count decreased throughout the DJBL implantation period along with decreased ferritin, iron and vitamin B12 concentrations. Blood count returned to baseline values 3 months after DJBL removal. Decreased body weight and improved glucose control persisted with only slight deterioration 3 months after DJBL removal while the effect on lipids was lost. We conclude that the implantation of DJBL induced a sustained reduction in body weight and improvement in regulation of lipid and glucose. The increase in FGF19 and bile acids levels could be at least partially responsible for these effects.

Maintenance of efficacy after duodenal– jejunal bypass liner explantation in the first NHS EndoBarrier service

“…This form of reversible bariatric procedure has been shown to reduce weight and improve glycaemic control in patients with diabetes and obesity. [2][3][4][5] REVISEDiabesity (Randomisation to Endobarrier alone Versus with Incretin analogue in SustainEd Diabesity), an Association of British Clinical Diabetologists (ABCD) UK-funded, multicentre, randomised controlled trial (ISRCTN00151053) led by our institution supports these observations. Additionally, preliminary data on the first year of treatment with the EndoBarrier device combined with liraglutide therapy showed benefit on HbA1c and weight/body mass index (BMI), liver fat and cardiovascular risk, as measured by the UK Prospective Diabetes Study (UKPDS) risk engine v2.…”

Influence of glucometric ‘dynamical’ variables on duodenal‐jejunal bypass liner (DJBL) anthropometric and metabolic outcomes

“…The methodology and outcomes of the performed DJBL study have been described in detail elsewhere . Briefly, 30 obese T2DM individuals (20 males, 10 females, aged 33‐65 years, HbA 1C > 53 mmol/mol) were subjected to 10 months of treatment with DJBL.…”

“…Besides the weight loss associated with DJBL implantation, a combination of neuroendocrine and metabolic mechanisms has been proposed, including a reduced secretion of diabetogenic hormones in the proximal intestine due to the lack of nutrients‐induced stimuli (foregut hypothesis), or an increased secretion of incretins in response to undigested food in the distal small intestine (hindgut hypothesis) . More recently, changes in other gut hormones and bile acids along with their regulator fibroblast growth factor 19 have also been implied …”

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

“…Small prospective studies have demonstrated promising improvements in diabetes control and loss of body weight . To obtain prospective data in a larger cohort of patients, the ENDO Trial, a multicentre, double‐blind, randomized trial, was conducted to evaluate the safety and efficacy of the DJBL.…”

“…9,10 Small prospective studies have demonstrated promising improvements in diabetes control and loss of body weight. [11][12][13][14][15][16][17][18][19][20][21] To obtain prospective data in a larger cohort of patients, the ENDO Trial, a multicentre, double-blind, randomized trial, was conducted to evaluate the safety and efficacy of the DJBL. However, in March 2015, the US FDA discontinued enrollment of patients because of complications in the form of 7 hepatic abscesses.…”