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Weight reduction and improvement in diabetes by the duodenal-jejunal bypass liner: a 198 patient cohort study

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Abstract

Background

The duodenal-jejunal bypass liner (DJBL) is an endoscopic treatment for patients with type 2 diabetes mellitus (T2DM) and (morbid) obesity. The aim of the current study was to determine its efficacy and safety profile.

Methods

Inclusion criteria for treatment with a DJBL were: age 18–70 years, BMI 28–45 kg/m2, and T2DM with a HbA1c > 48 mmol/mol. Primary outcomes were changes in HbA1c and body weight. Secondary outcomes included changes in blood pressure, lipids, and anti-diabetic medication. Predictive factors for success of treatment with the DJBL were determined.

Results

Between 2011 and 2014, 185 out of 198 patients successfully underwent a DJBL implantation procedure, with an intended implantation time of 12 months. In these 185 patients, body weight decreased by 12.8 ± 8.0 kg (total body weight loss of 11.9 ± 6.9 %, p < 0.001), HbA1c decreased from 67 to 61 mmol/mol (p < 0.001) despite a reduction in anti-diabetic medication, and blood pressure and serum lipid levels all decreased. In total, 57 (31 %) DJBLs were explanted early after a median duration of 33 weeks. Adverse events occurred in 17 % of patients. C-peptide ≥1.0 nmol/L and body weight ≥107 kg at screening were independent predictive factors for success.

Conclusions

Treatment with the DJBL in T2DM patients with (morbid) obesity results in improvement in glucose control, a reduction in anti-diabetic medication, and significant weight loss. The largest changes are observed within the first 3–6 months. Initial C-peptide levels and body weight may help to select patients with the greatest chance of success.

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Authors and Affiliations

  1. Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800 TA, Arnhem, The Netherlands

    Bark Betzel, Jens Homan, Edo O. Aarts, Ignace M. C. Janssen & Frits J. Berends

  2. Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands

    Hans de Boer

  3. Department of Gastroenterology, Rijnstate Hospital, Arnhem, The Netherlands

    Peter J. Wahab & Marcel J. M. Groenen

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  1. Bark Betzel
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  2. Jens Homan
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Correspondence to Bark Betzel.

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Disclosures

Dr. I.M.C. Janssen received financial research support and consultancy fees from GI Dynamics. Dr. B. Betzel, Dr. J. Homan, Dr. E.O. Aarts, Dr. H. de Boer, Dr. P.J. Wahab, Dr. M.J.M. Groenen, and Dr. F.J. Berends have no conflicts of interest or financial ties to disclose.

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Betzel, B., Homan, J., Aarts, E.O. et al. Weight reduction and improvement in diabetes by the duodenal-jejunal bypass liner: a 198 patient cohort study. Surg Endosc 31, 2881–2891 (2017). https://doi.org/10.1007/s00464-016-5299-6

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