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Relevant Weight Reduction and Reversed Metabolic Co-morbidities Can Be Achieved by Duodenojejunal Bypass Liner in Adolescents with Morbid Obesity

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Abstract

Background

Duodenojejunal bypass liner (DJBL) is an endoscopic, reversible bariatric procedure resulting in weight loss and metabolic co-morbidities improvements in the adults.

Objectives

To determine safety and effectiveness of 12-month treatment with DJBL in adolescents with severe obesity (BMI > 35 kg/m2) and co-morbidities.

Methods

Post-pubertal subjects were treated with DJBL in an open-label, prospective clinical trial (NTC0218393). They were examined at 3 monthly intervals during the 12 months of DJBL treatment and 12 months of follow-up.

Results

DJBL was successfully placed in 19/22 adolescents (13 females, mean age (95%CI); 17.3 (16.7–17.9) years, BMI-SDS 3.7 (3.6–3.9)). There were no serious device-related adverse effects. Clinically relevant percent total weight loss (%TWL) (mean (95%CI)) 11.4 (7.4–15.3) % and BMI decrease − 4.9 (− 2.4 to − 7.4) kg/m2 was observed at DJBL removal (n = 19). At 12 months after device removal, %TWL was 4.1 (− 2.6–10.8) % and BMI decrease − 2.6 (0.2 to − 5.4) kg/m2 when compared with values at baseline (n = 13). HOMA-IR (− 2.1 (− 3 to − 1.3), WBISI 1.15 (0.23 to 2.07), total cholesterol, LDL-c, and triglycerides levels also improved during DJBL treatment and relapsed similarly to weight at 12-month follow-up. A decrease in iron stores, Zn, and Se levels was determined during DJBL treatment and spontaneously improved at follow-up.

Conclusions

Twelve months of DJBL treatment was safe and effective in adolescents with morbid obesity. Weight regain following device removal and relapse of metabolic complications should be expected.

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References

  1. Juonala M, Magnussen CG, Berenson GS, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med. 2011;365(20):1876–85.

    Article  CAS  PubMed  Google Scholar 

  2. Simmonds M, Llewellyn A, Owen CG, et al. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17(2):95–107.

    Article  CAS  PubMed  Google Scholar 

  3. Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(3):709–57.

    PubMed  PubMed Central  Google Scholar 

  4. Nobili V, Vajro P, Dezsofi A, et al. Indications and limitations of bariatric intervention in severely obese children and adolescents with and without nonalcoholic steatohepatitis: ESPGHAN Hepatology Committee Position Statement. J Pediatr Gastroenterol Nutr. 2015;60(4):550–61.

    Article  PubMed  Google Scholar 

  5. Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obes Facts. 2013;6(5):449–68.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Olbers T, Beamish AJ, Gronowitz E, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol. 2017;5(3):174–83.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113–23.

    Article  CAS  PubMed  Google Scholar 

  8. Longitudinal Assessment of Bariatric Surgery C, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.

    Article  Google Scholar 

  9. Quezada N, Munoz R, Morelli C, et al. Safety and efficacy of the endoscopic duodenal-jejunal bypass liner prototype in severe or morbidly obese subjects implanted for up to 3 years. Surg Endosc. 2018;32(1):260–7.

    Article  PubMed  Google Scholar 

  10. Vilarrasa N, de Gordejuela AG, Casajoana A, et al. Endobarrier(R) in Grade I Obese Patients with long-standing type 2 diabetes: role of gastrointestinal hormones in glucose metabolism. Obes Surg. 2017;27(3):569–77.

    Article  PubMed  Google Scholar 

  11. Zechmeister-Koss I, Huic M, Fischer S. European Network for Health Technology A. The duodenal-jejunal bypass liner for the treatment of type 2 diabetes mellitus and/or obesity: a systematic review. Obes Surg. 2014;24(2):310–23.

    Article  PubMed  Google Scholar 

  12. Rodriguez-Grunert L, Galvao Neto MP, Alamo M, et al. First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve. Surg Obes Relat Dis. 2008;4(1):55–9.

    Article  PubMed  Google Scholar 

  13. Betzel B, Cooiman MI, Aarts EO, et al. Clinical follow-up on weight loss, glycemic control, and safety aspects of 24 months of duodenal-jejunal bypass liner implantation. Surg Endosc. 2019:1–7. https://doi.org/10.1007/s00464-019-06752-8.

  14. 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.

    Article  PubMed  Google Scholar 

  15. Sacks DB, Bruns DE, Goldstein DE, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2002;48(3):436–72.

    Article  CAS  PubMed  Google Scholar 

  16. Zeitler P, Arslanian S, Fu J, et al. ISPAD Clinical Practice Consensus Guidelines 2018: type 2 diabetes mellitus in youth. Pediatr Diabetes. 2018;19(Suppl 27):28–46.

    Article  PubMed  Google Scholar 

  17. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999;22(9):1462–70.

    Article  CAS  PubMed  Google Scholar 

  18. Joseph AE, Saverymuttu SH. al-Sam S, Cook MG, Maxwell JD. Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol. 1991;43(1):26–31.

    Article  CAS  PubMed  Google Scholar 

  19. Saverymuttu SH, Joseph AE, Maxwell JD. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J (Clin Res Ed). 1986;292(6512):13–5.

    Article  CAS  Google Scholar 

  20. Jones NL, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN Guidelines for the management of helicobacter pylori in children and adolescents (Update 2016). J Pediatr Gastroenterol Nutr. 2017;64(6):991–1003.

    Article  PubMed  Google Scholar 

  21. Rohde U, Hedback N, Gluud LL, et al. Effect of the EndoBarrier Gastrointestinal liner on obesity and type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2016;18(3):300–5.

    Article  CAS  PubMed  Google Scholar 

  22. Force ABET, Sullivan S, Kumar N, et al. ASGE position statement on endoscopic bariatric therapies in clinical practice. Gastrointest Endosc. 2015;82(5):767–72.

    Article  Google Scholar 

  23. 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;255(6):1080–5.

    Article  PubMed  Google Scholar 

  24. Ryder JR, Kaizer AM, Jenkins TM, et al. Heterogeneity in response to treatment of adolescents with severe obesity: the need for precision obesity medicine. Obesity (Silver Spring). 2019;27(2):288–94.

    Article  Google Scholar 

  25. Inge TH, Coley RY, Bazzano LA, et al. Comparative effectiveness of bariatric procedures among adolescents: the PCORnet bariatric study. Surg Obes Relat Dis. 2018;14(9):1374–86.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Weiss R, Bremer AA, Lustig RH. What is metabolic syndrome, and why are children getting it? Ann N Y Acad Sci. 2013;1281:123–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Nobili V, Bedogni G, Berni Canani R, et al. The potential role of fatty liver in paediatric metabolic syndrome: a distinct phenotype with high metabolic risk? Pediatr Obes. 2012;7(6):e75–80.

    Article  CAS  PubMed  Google Scholar 

  28. Inge TH, Courcoulas AP, Jenkins TM, et al. Five-year outcomes of gastric bypass in adolescents as compared with adults. N Engl J Med. 2019;380(22):2136–45.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nobili V, Alkhouri N, Alisi A, et al. Nonalcoholic fatty liver disease: a challenge for pediatricians. JAMA Pediatr. 2015;169(2):170–6.

    Article  PubMed  Google Scholar 

  30. Weng TC, Chang CH, Dong YH, et al. Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ Open. 2015;5(7):e006964.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Moize V, Deulofeu R, Torres F, et al. Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population. Obes Surg. 2011;21(9):1382–8.

    Article  PubMed  Google Scholar 

  32. Vilarrasa N, Fabregat A, Toro S, et al. Nutritional deficiencies and bone metabolism after endobarrier in obese type 2 patients with diabetes. Eur J Clin Nutr. 2018;72(10):1447–50.

    Article  PubMed  Google Scholar 

  33. Benotti PN, Wood GC, Still CD, et al. Metabolic surgery and iron homeostasis. Obes Rev. 2019;20(4):612–20.

    Article  PubMed  Google Scholar 

  34. Stein EM, Silverberg SJ. Bone loss after bariatric surgery: causes, consequences, and management. Lancet Diabetes Endocrinol. 2014;2(2):165–74.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Authors thank all the participating adolescents and their families for their commitment to the study protocol. We thank all members of the endoscopic bariatric team, especially Tomaž Poredoš, dietitian and Simona Klemenčič, psychologist for their dedicated work. Authors also thank radiologist Dr. Martin Thaler for performing and evaluating the ultrasonographic images of the liver. Devices used were kindly provided by GI Dynamics Inc., Lexington, MA, USA.

Funding

Study was supported by the Slovenian Research Agency grants P3-0343 and J3-6798 and the University Medical Centre Ljubljana grant No. 20100364.

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Nutrition, University Children’s hospital, University Medical Center Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia

    Matjaž Homan & Rok Orel

  2. Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia

    Matjaž Homan, Rok Orel, Tadej Battelino & Primož Kotnik

  3. Unit of Special Laboratory Diagnostics, University Children’s Hospital, University Medical Center Ljubljana, Vrazov trg 1, SI-1000, Ljubljana, Slovenia

    Jernej Kovač

  4. Department of Endocrinology, Diabetes And Metabolism, University Children’s Hospital, University Medical Center Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia

    Tadej Battelino & Primož Kotnik

Authors
  1. Matjaž Homan
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  2. Jernej Kovač
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Corresponding author

Correspondence to Matjaž Homan.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The trial was conducted according to the principles of good clinical practice and the Declaration of Helsinki with amendments. The study was approved by The Republic of Slovenia National Medical Ethics Committee (#39/03/14) and by the Competent Authority, and registered at www.clinicaltrials.gov (NCT02183935).

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Homan, M., Kovač, J., Orel, R. et al. Relevant Weight Reduction and Reversed Metabolic Co-morbidities Can Be Achieved by Duodenojejunal Bypass Liner in Adolescents with Morbid Obesity. OBES SURG 30, 1001–1010 (2020). https://doi.org/10.1007/s11695-019-04279-4

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