PURPOSE: Obesity and its related severe comorbidities are increasing rapidly. The duodenal-jejunal bypass is an endoscopically implanted device (mimicking the Roux-en-Y gastric bypass) developed to support weight reduction and improve type 2 diabetes control. MATERIALS AND METHODS: Retrospective data analysis of consecutive patients undergoing duodenal-jejunal bypass (EndoBarrier®, DJB) implantation between 2013 and 2017 was performed to evaluate safety as well as short- and long-term efficacy. RESULTS: One hundred and twenty-one patients (mean BMI of 43.1 ± 7.2 kg/m2 and weight of 138.2 ± 28.6 kg) underwent DJB implantation. The mean dwelling time was 15.5 months, the mean total body weight loss (%TBWL) after explantation was 10.3% ± 7.9% (14.2 kg, p < 0.0001), and the mean BMI was 39.5 ± 7.3 kg/m2 (p < 0.0001). There was no significant weight gain 24 months after the explantation. Seventy-seven patients had type 2 diabetes mellitus (T2DM) with a mean HbA1c before implantation of 5.6% (n = 52). The mean HbA1c after explantation was 5.1% (p = 0.0001). Significant reductions in transaminase and lipid levels before and after explantation were observed. One complication occurred during implantation and another during explantation. In 16 patients, the device had to be extracted earlier than expected (7 for severe adverse events and 9 for adverse events; 13.2%). CONCLUSION: Despite an evident rate of adverse events, the DJB shows promise as a weight-loss procedure. Our results show that some patients implanted with the device maintained reduced weight even 24 months after explantation, while many improved T2DM control.

Department of Hepatogastroenterology Institute for Clinical and Experimental Medicine Videnska 1958 9 140 21 Prague Czech Republic

Department of Internal Medicine 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Statistics Institute for Clinical and Experimental Medicine Videnska 1958 9 140 21 Prague Czech Republic

Zobrazit více v PubMed

Eurostat. Over half of adults in the EU are overweight. 2021. https://ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20210721-2.

Adult Obesity Facts. 2020. https://www.cdc.gov/obesity/data/adult.html.

Overweight and obesity. BMI statistics. 2019. https://ec.europa.eu/eurostat/statistics-explained/index.php/Overweight_and_obesity_-_BMI_statistics.

Kral J, et al. Endoscopic treatment of obesity and nutritional aspects of bariatric endoscopy. Nutrients. 2021;13(12):4268. doi: 10.3390/nu13124268. PubMed DOI PMC

Okunogbe A, Nugent R, Spencer G, et al. Economic impacts of overweight and obesity: current and future estimates for eight countries. BMJ Glob Health. 2021;6(10):e006351. doi: 10.1136/bmjgh-2021-006351. PubMed DOI PMC

Bluher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15:288–298. doi: 10.1038/s41574-019-0176-8. PubMed DOI

Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376:254–266. doi: 10.1056/NEJMra1514009. PubMed DOI

Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterology. 2012;142:711–U109. doi: 10.1053/j.gastro.2012.02.003. PubMed DOI

Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev (Online) 2014;2014(10):Cd003641. doi: 10.1002/14651858.CD003641.pub4. PubMed DOI PMC

Gloy VL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. doi: 10.1136/bmj.f5934. PubMed DOI PMC

Buchwald H, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA J Am Med Assoc. 2004;292:1724–1737. doi: 10.1001/jama.292.14.1724. PubMed DOI

Forner PM, Ramacciotti T, Farey JE, et al. Safety and effectiveness of an endoscopically placed duodenal-jejunal bypass device (EndoBarrierA (R)): outcomes in 114 patients. Obes Surg. 2017;27:3306–3313. doi: 10.1007/s11695-017-2939-4. PubMed DOI

Koehestanie P, et al. The effect of the endoscopic duodenal-jejunal bypass liner on obesity and type 2 diabetes mellitus, a multicenter randomized controlled trial. Ann Surg. 2014;260:984–992. doi: 10.1097/SLA.0000000000000794. PubMed DOI

Patel N, et al. EndoBarrier (R): a safe and effective novel treatment for obesity and type 2 diabetes? Obes Surg. 2018;28:1980–1989. doi: 10.1007/s11695-018-3123-1. PubMed DOI PMC

SERVICES, U. S. D. O. H. A. H. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. (2017).

Abu Dayyeh BK, et al. Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial. Lancet. 2021;398:1965–1973. doi: 10.1016/S0140-6736(21)02394-1. PubMed DOI

Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138:957–961. doi: 10.1001/archsurg.138.9.957. PubMed DOI

Marczuk P, et al. Effectiveness and safety of Roux-en-Y gastric bypass in elderly patients-systematic review and meta-analysis. Obes Surg. 2019;29:361–368. doi: 10.1007/s11695-018-3546-8. PubMed DOI

Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:1171–1177. doi: 10.1007/s11695-010-0145-8. PubMed DOI

Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384:989–1002. doi: 10.1056/NEJMoa2032183. PubMed DOI

Ruban A, et al. Duodenal-jejunal bypass liner for the management of type 2 diabetes mellitus and obesity: a multicenter randomized controlled trial. Ann Surg. 2022;275:440–447. doi: 10.1097/SLA.0000000000004980. PubMed DOI PMC

van Rijn S, Roebroek YGM, de Jonge C, et al. Effect of the endobarrier device: a 4-year follow-up of a multicenter randomized clinical trial. Obes Surg. 2019;29:1117–1121. doi: 10.1007/s11695-018-03659-6. PubMed DOI

Birkmeyer NJO, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA J Am Med Assoc. 2010;304:435–442. doi: 10.1001/jama.2010.1034. PubMed DOI

Ibrahim Mohamed BK, Barajas-Gamboa JS, Rodriguez J. Endoscopic bariatric therapies: current status and future perspectives. JSLS. 2022;26(1):e2021.00066. doi: 10.4293/JSLS.2021.00066. PubMed DOI PMC

Hedjoudje A, et al. Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis. Clin gastroenterol Hepatol: Off Clin Pract J Am Gastroenterol Assoc. 2020;18:1043–1053 e1044. doi: 10.1016/j.cgh.2019.08.022. PubMed DOI

Vargas EJ, et al. Single fluid-filled intragastric balloon safe and effective for inducing weight loss in a real-world population. Clinical Gastroenterol Hepatol: Off Clin Pract J Am Gastroenterol Assoc. 2018;16:1073–1080 e1071. doi: 10.1016/j.cgh.2018.01.046. PubMed DOI PMC

Wadden TA, et al. Liraglutide 3.0 mg and Intensive Behavioral Therapy (IBT) for Obesity in Primary Care: The SCALE IBT Randomized Controlled Trial. Obesity (Silver Spring) 2020;28:529–536. doi: 10.1002/oby.22726. PubMed DOI PMC

Extending limits: the longest recorded duodenojejunal bypass implant