Obesity Surgery

, Volume 29, Issue 4, pp 1117–1121 | Cite as

Effect of the EndoBarrier Device: a 4-Year Follow-up of a Multicenter Randomized Clinical Trial

  • Selwyn van Rijn
  • Yvonne G. M. Roebroek
  • Charlotte de Jonge
  • Jan Willem M. Greve
  • Nicole D. BouvyEmail author
Original Contributions



To evaluate the long-term effect of the duodenal-jejunal bypass liner (DJBL) on weight loss and glycemic control.


Data on the long-term effect of DJBL treatment is still missing.


From 2010 to 2012, 29 patients were treated with the DJBL at center A and center B, as part of a multicenter randomized controlled trial. Prior to implantation and after removal of the DJBL, all patients underwent standardized physical examination and blood sampling. Four years after removal of the DJBL, included patients underwent standardized physical examination and blood sampling as previously performed during the initial study.


Out of the 29 patients, 15 patients were eligible for follow-up with a median duration of 42 months. Five patients had successfully received additional bariatric surgery. Four years after explantation of the DJBL, median weight in these 15 patients was 102.0 kg (IQR 94.0–124.6), which was not statistically significantly different from the 106.1 kg at baseline (IQR 99.0–128.4). Median BMI changed from 33.1 kg/m2 (IQR 32.3–38.5) at baseline to 33.7 kg/m2 (IQR 31.2–36.9) after follow-up. Patients had a TWL of 2.2% (IQR − 1.3–5.6) compared to baseline weight. None of the parameters were significantly different after follow-up compared to baseline.


The effect of weight reduction of initial DJBL treatment seems to be diminished after 4 years of follow-up. However, larger prospective studies with long-term follow-up need to be conducted in the future.


Obesity Abdominal surgery Duodenal-jejunal bypass liner Type 2 diabetes mellitus 


Compliance with Ethical Standards

Conflict of Interest

Author 1 has no conflict of interest or financial ties to disclose.

Author 2 has no conflict of interest or financial ties to disclose.

Author 3 has no conflict of interest or financial ties to disclose.

Author 4 reports to have received grants from GI Dynamics and personal fees from GI Dynamics and is a member of the scientific advisory board of GI Dynamics since February 2017.

Author 5 has no conflict of interest or financial ties to disclose.


  1. 1.
    Health and Social Care Information Centre LS. Statistics on Obesity. England: Physical Activity and Diet; 2013. NHS, 2013 9 may 2013. Report No.: 2Google Scholar
  2. 2.
    Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–14.CrossRefGoogle Scholar
  3. 3.
    Schiller JS, Lucas JW, Ward BW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Vital Health Stat 10. Data from the National Health Survey. 2012;(252):1–207.Google Scholar
  4. 4.
    Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006 Dec 14;444(7121):840–6.CrossRefGoogle Scholar
  5. 5.
    Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444(7121):875–80.CrossRefGoogle Scholar
  6. 6.
    Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obesity Facts. 2013;6(5):449–68.CrossRefGoogle Scholar
  7. 7.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(Suppl 1):S1–27.CrossRefGoogle Scholar
  8. 8.
    Maiz C, Alvarado J, Quezada N, et al. Bariatric surgery in 1119 patients with preoperative body mass index < 35 (kg/m(2)): results at 1 year. Surg Obes Relat Dis. 2015;11(5):1127–32.CrossRefGoogle Scholar
  9. 9.
    O'Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144(9):625–33.CrossRefGoogle Scholar
  10. 10.
    Sultan S, Parikh M, Youn H, et al. Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2. Surg Endosc. 2009;23(7):1569–73.CrossRefGoogle Scholar
  11. 11.
    Mathus-Vliegen EM. Endoscopic treatment: the past, the present and the future. Best Pract Res Clin Gastroenterol. 2014;28(4):685–702.CrossRefGoogle Scholar
  12. 12.
    van Rijn S, Roebroek YG, Masclee AA, et al. Structural endoscopic techniques to treat obesity: a review. Surg Technol Int. 2015;26:84–91.Google Scholar
  13. 13.
    Koehestanie P, de Jonge C, Berends FJ, 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(6):984–92.CrossRefGoogle Scholar
  14. 14.
    Betzel B, Homan J, Aarts EO, Janssen IM, de Boer H, Wahab PJ, et al. Weight reduction and improvement in diabetes by the duodenal-jejunal bypass liner: a 198 patient cohort study. Surg Endosc. 2016.Google Scholar
  15. 15.
    Escalona A, Pimentel F, Sharp A, et al. Weight loss and metabolic improvement in morbidly obese subjects implanted for 1 year with an endoscopic duodenal-jejunal bypass liner. Ann Surg. 2012 Jun;255(6):1080–5.CrossRefGoogle Scholar
  16. 16.
    de Moura EG, Martins BC, Lopes GS, et al. Metabolic improvements in obese type 2 diabetes subjects implanted for 1 year with an endoscopically deployed duodenal-jejunal bypass liner. Diabetes Technol Ther. 2012;14(2):183–9.CrossRefGoogle Scholar
  17. 17.
    Gersin KS, Rothstein RI, Rosenthal RJ, et al. Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc. 2010;71(6):976–82.CrossRefGoogle Scholar
  18. 18.
    Schouten R, Rijs CS, Bouvy ND, et al. A multicenter, randomized efficacy study of the EndoBarrier gastrointestinal liner for presurgical weight loss prior to bariatric surgery. Ann Surg. 2010;251(2):236–43.CrossRefGoogle Scholar
  19. 19.
    Diamantis T, Apostolou KG, Alexandrou A, et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1):177–83.CrossRefGoogle Scholar
  20. 20.
    Edholm D, Svensson F, Naslund I, et al. Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis. 2013;9(5):708–13.CrossRefGoogle Scholar
  21. 21.
    Mehaffey JH, LaPar DJ, Clement KC, et al. 10-year outcomes after Roux-en-Y gastric bypass. Ann Surg. 2016;264(1):121–6.CrossRefGoogle Scholar
  22. 22.
    Betzel B, Koehestanie P, Aarts EO, et al. Safety experience with the duodenal-jejunal bypass liner: an endoscopic treatment for diabetes and obesity. Gastrointest Endosc. 2015;82(5):845–52.CrossRefGoogle Scholar
  23. 23.
    Koehestanie P, Betzel B, Aarts EO, et al. Is reimplantation of the duodenal-jejunal bypass liner feasible? Surg Obes Relat Dis. 2015;11(5):1099–104.CrossRefGoogle Scholar
  24. 24.
    Langeveld M, DeVries JH. The long-term effect of energy restricted diets for treating obesity. Obesity. 2015;23(8):1529–38.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
  3. 3.Department of General SurgeryZuyderland Medical Center HeerlenHeerlenThe Netherlands

Personalised recommendations