Open label, prospective, randomized controlled trial of an endoscopic duodenal-jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery.
BACKGROUND
The duodenal-jejunal bypass sleeve (DJBS) has been shown to achieve a completely endoscopic duodenal exclusion without the need for stapling. This report is the first randomized controlled trial for weight loss.


METHODS
In a 12-week, prospective, randomized study, subjects received either a low fat diet and the DJBS or a low fat diet control (no device). Twenty-five patients were implanted with the device and 14 received the control. The groups were demographically similar. Both groups received counseling at baseline only, which consisted of a low calorie diet, and exercise/behavior modification advice. No additional counseling occurred in either group. Measurements included starting and monthly body weight and serum blood tests. The device group also had a plain abdominal film post implant, a monthly KUB and a 4-week post explant EGD.


RESULTS
Twenty device (80%) subjects maintained the DJBS without a significant adverse event for the 12-week duration. At 12 weeks, the mean excess weight loss was 22% and 5% for the device and control groups, respectively (p < 0.001). Five subjects (20%) were endoscopically explanted early secondary to upper GI (UGI) bleeding (n = 3), anchor migration (n = 1) and sleeve obstruction (n = 1). The UGI bleeding occurred at a mean of 13.8 days post implant. EGD was performed in each of these cases with no distinct bleeding source identified. No blood transfusion was required. The migration occurred on day 47 and manifested as abdominal pain. The subject with the sleeve obstruction presented with abdominal pain and vomiting on day 30. Eight subjects (40%) underwent the 4 week post explant EGD at which time mild degrees of residual duodenal inflammation was noted.


CONCLUSIONS
The DJBS achieves noninvasive duodenal exclusion and short term weight loss efficacy. Longer term randomized controlled sham trials for weight loss and treatment of T2DM are underway.
Tarnoff
M
M
Department of Surgery, Tufts-New England Medical Center, Boston, MA, USA. mtarnoff@tuftsmedicalcenter.org
Rodriguez
L
L
Escalona
A
A
Ramos
A
A
Neto
M
M
Alamo
M
M
Reyes
E
E
Pimentel
F
F
Ibanez
L
L
D000328:Adult; D050110:Bariatric Surgery / Q000295:instrumentation*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004038:Diet, Reducing; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D016896:Treatment Outcome; D015431:Weight Loss