Surgical Endoscopy

, Volume 22, Issue 3, pp 772–776 | Cite as

Acute technical feasibility of an endoscopic duodenal-jejunal bypass sleeve in a porcine model: a potentially novel treatment for obesity and type 2 diabetes

Article

Abstract

Background

The concept of endoluminal therapy for various disease states has gained significant attention. This report describes the authors’ initial animal experience with a novel endoscopic duodenal-jejunal bypass sleeve (DJBS) in a porcine model. The DJBS consists of an implant delivered endoscopically, anchored in the proximal duodenum, and extended into the jejunum. This device aims to mimic the intestinal bypass effects of Roux-en-y gastric bypass without the need for stapling or anastomosis and may offer novel therapeutic benefit for patients with obesity, type 2 diabetes, or both.

Methods

Five DJBS devices were delivered in five domestic, female Yorkshire pigs. The devices were delivered and retrieved the same day and left in situ for less than 1 h. The animals were kept alive for 4 days after explantation for evaluation of their general health after the procedure. After they were killed, gastric, duodenal, and jejunal tissues were examined and harvested for histologic assessment of any acute device or procedure-related effects.

Results

Delivery of the implant took an average of 18 min (range, 10–38 min) and required an average fluoroscopy time of 8.1 min (range, 3.8–16.6 min). Retrievals were performed in an average of 7.4 min (range, 5–9 min) using fluoroscopy for an average of 2.3 min (range, 1.3–4.5 min). Followed for 4 days after explantation, the animals were normal and healthy. There were no pathologic findings in the explanted tissue.

Conclusions

The DJBS can be safely deployed and retrieved endoscopically. Future long-term survival studies are warranted to help define the role of promising technology.

Keywords

Bariatric Endoluminal Diabetes Duodenum Obesity 

References

  1. 1.
    Shikora S, Kim J, Tarnoff M (2005) Laparoscopic Roux-y gastric bypass: results and learning curve of a high-volume academic practice. Arch Surg 104:362–367CrossRefGoogle Scholar
  2. 2.
    Parikh MS, Fielding GA, Ren CJ (2005) U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes. Surg Endosc 19:1631–1635PubMedCrossRefGoogle Scholar
  3. 3.
    Gostout CJ, Rajan E (2005) Endoscopic treatments for obesity: past, present, and future. Gastroenterol Clin North Am 34:143–150PubMedCrossRefGoogle Scholar
  4. 4.
    Hu B, Chung SC, Sun LC, Kawashima T, Cotton PB, Gostout CJ, Hawes RH, Kalloo AN, Kantsevoy SV, Pasricha PJ (2004) Transoral obesity surgery: endoluminal gastroplasty with an endoscopic suture device. Endoscopy 37:411–414CrossRefGoogle Scholar
  5. 5.
    Schweitzer M (2004) Endoscopic intraluminal suture placation of the gastric pouch and stoma in post operative Roux-y gastric bypass patients. J Laparoendosc Adv Surg Tech 14:223–226Google Scholar
  6. 6.
    Garcia-Compean D, Mendoza-Fuerte E, Martinez JA, Villarreal I, Maldonado H (2005) Endoscopic injection of botulinum toxin in the gastric antrum for the treatment of obesity: results of a pilot study. Gastroenterol Clin Biol 29:789–791PubMedCrossRefGoogle Scholar
  7. 7.
    Genco A, Cipriano M, Bacci V, Cuzzolaro M, Materia A, Raparelli L, Docimo C, Lorenzo M, Basso N (2006) BioEnterics (R) intragastric balloon (BIB[R]): a short-term, double-blind, randomised, controlled, crossover study on weight reduction in morbidly obese patients. Int J Obes Lond 30:129–133PubMedCrossRefGoogle Scholar
  8. 8.
    Vittal H, Raju GS (2005) Endoscopic bubble: can it bust the obesity bubble? Gastroenterology 129:1130–1132PubMedCrossRefGoogle Scholar
  9. 9.
    Cigaina V (2002) Gastric pacing as therapy for morbid obesity: preliminary results. Obes Surg 12:12s–16sPubMedCrossRefGoogle Scholar
  10. 10.
    Shikora SA (2004) Implantable gastric stimulation for the treatment of severe obesity. Obes Surg 14:545–548PubMedCrossRefGoogle Scholar
  11. 11.
    Dargent J (2002) Implantable gastric stimulation as therapy for morbid obesity: preliminary results from the French study. Obes Surg 12:21S–24SCrossRefGoogle Scholar
  12. 12.
    Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, Castagneto M, Marescaux J (2006) The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 244:741–749PubMedCrossRefGoogle Scholar
  13. 13.
    National Institute of Health (2006) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. http://www.nhlbi.gov/guidelines/obesity/obxsum.htm. Accessed February 2006

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of SurgeryTufts New England Medical CenterBostonUSA
  2. 2.Department of GastroenterologyBeth Israel Medical CenterBostonUSA

Personalised recommendations