title: Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels.
abstract: OBJECTIVE
  Endoscopic implantation of a duodenal-jejunal bypass liner (DJBL) is a novel bariatric technique to induce weight loss and remission of type 2 diabetes mellitus. Placement of the DJBL mimics the bypass component of the Roux-en-Y gastric bypass (RYGB) procedure. In this observational study, we evaluated improvement of glycemic control and weight loss in the course of the treatment (0 - 24 weeks after DJBL implantation) and analyzed accompanying gut hormone responses.
  
  
  METHODS
  12 obese individuals with type 2 diabetes were selected for DJBL implantation. Body weight, fat mass, and fasting plasma levels of glucose, insulin, C-peptide, and glycated hemoglobin (HbA1c), were analyzed at 0, 1, 4 and 24 weeks post-implant. Fasting ghrelin, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP-1) were determined at 0, 1 and 4 weeks post-implant.
  
  
  RESULTS
  Besides significant weight loss, fat mass, fasting insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) index were also significantly decreased after DJBL implantation and a 42 % reduction was found in diabetes medication (P < 0.05). The fasting GLP-1 response in the first 4 weeks post-implant was significantly correlated with the fasting insulin and HOMA-IR response. Fasting ghrelin was found to be significantly elevated, in contrast to the decrease in ghrelin that is found after RYGB surgery.
  
  
  CONCLUSIONS
  DJBL implantation provoked significant weight loss, a decrease in fat mass, and an early remission of type 2 diabetes, comparable to results seen after RYGB surgery. Gut hormone analyses revealed a potential role of fasting GLP-1 in early remission of type 2 diabetes. Interestingly, the DJBL-induced elevation of ghrelin contradicts the suggested role of reduced ghrelin levels after RYGB in improvement of glycemic control.
authors.affiliation: Department of General Surgery, Rijnstate, Arnhem, The Netherlands.
authors.forename: Parweez
authors.initials: P
authors.lastname: Koehestanie
authors.affiliation: Department of General Surgery, Rijnstate, Arnhem, The Netherlands.
authors.forename: Kemal
authors.initials: K
authors.lastname: Dogan
authors.affiliation: Department of General Surgery, Rijnstate, Arnhem, The Netherlands.
authors.forename: Frits
authors.initials: F
authors.lastname: Berends
authors.affiliation: Department of General Surgery, Rijnstate, Arnhem, The Netherlands.
authors.forename: Ignace
authors.initials: I
authors.lastname: Janssen
authors.affiliation: Department of Gastroenterology, Rijnstate, Arnhem, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Wahab
authors.affiliation: Department of Gastroenterology, Rijnstate, Arnhem, The Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: Groenen
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Müller
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: Nicole
authors.initials: N
authors.lastname: de Wit