title: Is reimplantation of the duodenal-jejunal bypass liner feasible?
abstract: BACKGROUND
  The endoscopic ally implanted DJBL is a 60-cm impermeable fluoropolymer device, which prevents food from making contact with the proximal intestine. It was designed to induce weight loss and treat type 2 diabetes mellitus (T2DM).
  
  
  OBJECTIVE
  To evaluate the feasibility, safety, and effectiveness of duodenal-jejunal bypass liner (DJBL) reimplantation.
  
  
  METHODS
  Prospective, observational study was conducted at the department of surgery and gastroenterology of the Rijnstate hospital, Arnhem, the Netherlands, between 2009 and 2011.
  
  
  METHODS
  Five obese patients with T2DM with body mass index (BMI) = Mass (kg) / height (m(2)), ranging from 30-35 kg/m(2) who completed the follow-up after their first implant and underwent removal of the DJBL after 6 months, were selected for reimplantation after an additional 18 months of follow-up. Weight loss, BMI, and HbA1 c were analyzed before and twelve months after reimplantation.
  
  
  RESULTS
  In all 5 patients, the DJBL was implanted and explanted without any complications. Also the reimplantation and reexplantation occurred without any complications. Median weight decreased significantly from 105 kg to 95 kg, and BMI decreased from 33 to 29. The glycated hemoglobin (HbA1 c) level decreased from 8.4% to 7.3% by the first implantation but it wasn't significant.
  
  
  CONCLUSIONS
  Reimplantation of DJBL is feasible, deemed safe, and showed additional weight loss.
authors.affiliation: Department of Surgery, Rijnstate Hospital, the Netherlands. Electronic address: p.koehestanie@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Koehestanie
authors.affiliation: Department of Surgery, Rijnstate Hospital, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Betzel
authors.affiliation: Department of Surgery, Rijnstate Hospital, the Netherlands.
authors.forename: E O
authors.initials: EO
authors.lastname: Aarts
authors.affiliation: Department of Surgery, Rijnstate Hospital, the Netherlands.
authors.forename: I M C
authors.initials: IM
authors.lastname: Janssen
authors.affiliation: Department of Gastroenterology, Rijnstate Hospital, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Wahab
authors.affiliation: Department of Surgery, Rijnstate Hospital, the Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: Berends
mesh_terms: D050110:Bariatric Surgery / Q000295:instrumentation / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D009426:Netherlands; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012092:Replantation / Q000295:instrumentation / Q000379:methods*; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: DJBL; Duodenal-jejunal bypass liner; Endobarrier; Obesity; Reimplantation; T2DM; Type 2 diabetes mellitus