title: Effects of Duodenal-Jejunal Bypass Liner (EndoBarrier®) on Gastric Emptying in Obese and Type 2 Diabetic Patients.
abstract: BACKGROUND
  The duodenal-jejunal bypass liner (DJBL) is a promising technique for treating obesity and type 2 diabetes mellitus (T2DM). However, despite promising results, its mechanism of action has not been elucidated. It is thought to promote changes in gastric emptying owing to the neuro-endocrine axis.
  
  
  OBJECTIVE
  The aim of this paper was to study DJBL-induced changes in gastric emptying and the relationship of those changes with weight loss and T2DM.
  
  
  METHODS
  Twenty-five patients with obesity and T2DM met inclusion criteria. Scintigraphic gastric emptying testing was performed prior to implantation, 16 weeks after implantation, and 4 weeks after removal. The average gastric retention was compared between tests, to examine the relationship between gastric emptying and those who lost more than 10 % of total body weight. Similarly, we compared average gastric retention between those who achieved a glycated hemoglobin target lower than 7 %.
  
  
  RESULTS
  Average gastric retention was greater after DJBL implantation compared with the baseline (first hour, 74 ± 16.3 %, p = 0.001; second hour, 45 ± 25 %, p < 0.001; fourth hour, 15.8 ± 15 %, p < 0.001). There was no difference between the baseline and 4 weeks after device removal (fourth hour, p = 0.057). Gastric retention was similar between patients who achieved T2DM control and those who did not (p = 0.73). Additionally, no difference was seen between patients who lost more than 10 % of body weight and those who did not (p = 0.275).
  
  
  CONCLUSIONS
  DJBL delays gastric emptying but is reversible after withdrawal. The changes in gastric emptying have no relationship to weight loss and T2DM control.
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo School of Medicine, São Paulo, Brazil, eduardoghdemoura@gmail.com.
authors.forename: Eduardo Guimarães Hourneaux
authors.initials: EG
authors.lastname: de Moura
authors.forename: Guilherme Sauniti
authors.initials: GS
authors.lastname: Lopes
authors.forename: Bruno Costa
authors.initials: BC
authors.lastname: Martins
authors.forename: Ivan Roberto Bonotto
authors.initials: IR
authors.lastname: Orso
authors.forename: Artur Martins Novaes
authors.initials: AM
authors.lastname: Coutinho
authors.forename: Suzana Lopes
authors.initials: SL
authors.lastname: de Oliveira
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
authors.forename: Manoel dos Passos
authors.initials: Mdos P
authors.lastname: Galvão-Neto
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Santo
authors.forename: Marcelo Tatit
authors.initials: MT
authors.lastname: Sapienza
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Buchpiguel
mesh_terms: D050110:Bariatric Surgery / Q000295:instrumentation*; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D004386:Duodenum / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007583:Jejunum / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011446:Prospective Studies; D019736:Prostheses and Implants; D011877:Radionuclide Imaging