Background:
Bariatric surgery is the most effective obesity treatment, however, less invasive options have recently been developed. The endoscopically placed duodenal-jejunal bypass sleeve (DJBS) (Endobarrier®) has been demonstrated to facilitate weight loss, but little is known about its impact on metabolic parameters.
Aim:
To assess the impact of the DJBS on metabolic outcomes in 15 patients with obesity and type 2 diabetes.
Methods:
The DJBS was implanted and remained in situ for up to 48 weeks. Subjects (M:F, 4:11) received medical and dietetic follow-up throughout. Liver biochemistry was monitored monthly. Hepatic fibrosis and intrahepatic fat (indicated by the Controlled Attenuation Parameter (CAP)) were assessed by hepatic transient elastography at baseline, 6 and 12 months. Glycaemic control and lipid profile were monitored every 4 months. Blood pressure was assessed at clinical reviews.
Results:
Body weight (123.8 ± 17.5 kg vs. 103.2 ± 16.8 kg; (p<0.0001)) and waist, hip and neck circumference (p<0.001; n=11) were significantly reduced. Liver function tests significantly improved (median alanine transaminase baseline: 34 U/L (29-49) vs. 19 U/L (16-23)); median aspartate transaminase baseline: 25 U/L (18 – 33) vs. 16 U/L (14 – 18); (p<0.0001)). Hepatic fibrosis was significantly reduced (11.0 ± 7.6 kPa vs. 6.2 ± 1.8 kPa (p<0.05)), likely due to a significant reduction in intrahepatic fat as indicated by a reduction in the CAP (347 ± 41 vs. 302 ± 47 decibels/m; p<0.001). In parallel, significant improvements in mean glycated haemoglobin and fasting glucose (p<0.05) and total cholesterol, triglycerides and very low density lipoprotein (p<0.01) were observed. There was no significant change in high density lipoprotein cholesterol or systolic or diastolic blood pressure.
Conclusion:
DJBS implantation resulted in significant improvements in hepatic and other metabolic indices over the intervention period. Long-term data is being collected in relation to metabolic parameters post-explant.