title: Endocrine effects of duodenal-jejunal exclusion in obese patients with type 2 diabetes mellitus.
abstract: Duodenal-jejunal bypass liner (DJBL) is an endoscopically implantable device designed to noninvasively mimic the effects of gastrointestinal bypass operations by excluding the duodenum and proximal jejunum from the contact with ingested food. The aim of our study was to assess the influence of DJBL on anthropometric parameters, glucose regulation, metabolic and hormonal profile in obese patients with type 2 diabetes mellitus (T2DM) and to characterize both the magnitude and the possible mechanisms of its effect. Thirty obese patients with poorly controlled T2DM underwent the implantation of DJBL and were assessed before and 1, 6 and 10months after the implantation, and 3months after the removal of DJBL. The implantation decreased body weight, and improved lipid levels and glucose regulation along with reduced glycemic variability. Serum concentrations of fibroblast growth factor 19 (FGF19) and bile acids markedly increased together with a tendency to restoration of postprandial peak of GLP1. White blood cell count slightly increased and red blood cell count decreased throughout the DJBL implantation period along with decreased ferritin, iron and vitamin B12 concentrations. Blood count returned to baseline values 3months after DJBL removal. Decreased body weight and improved glucose control persisted with only slight deterioration 3months after DJBL removal while the effect on lipids was lost. We conclude that the implantation of DJBL induced a sustained reduction in body weight and improvement in regulation of lipid and glucose. The increase in FGF19 and bile acids levels could be at least partially responsible for these effects.
authors.affiliation: Institute of Medical Biochemistry and Laboratory DiagnosticsFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Petra
authors.initials: P
authors.lastname: Kaválková
authors.affiliation: Third Department of Medicine - Department of Endocrinology and MetabolismFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Miloš
authors.initials: M
authors.lastname: Mráz
authors.affiliation: Third Department of Medicine - Department of Endocrinology and MetabolismFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Trachta
authors.affiliation: Institute of Medical Biochemistry and Laboratory DiagnosticsFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Kloučková
authors.affiliation: Institute of Medical Biochemistry and Laboratory DiagnosticsFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Anna
authors.initials: A
authors.lastname: Cinkajzlová
authors.affiliation: Institute of Medical Biochemistry and Laboratory DiagnosticsFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic Third Department of Medicine - Department of Endocrinology and MetabolismFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Zdeňka
authors.initials: Z
authors.lastname: Lacinová
authors.affiliation: Department of Sports MedicineFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Denisa
authors.initials: D
authors.lastname: Haluzíková
authors.affiliation: Department of Gastroenterology and HepatologyInstitute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Beneš
authors.affiliation: Department of DiabetesInstitute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Vlasáková
authors.affiliation: Department of CyberneticsFaculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic.
authors.forename: Václav
authors.initials: V
authors.lastname: Burda
authors.affiliation: Department of CyberneticsFaculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic.
authors.forename: Daniel
authors.initials: D
authors.lastname: Novák
authors.affiliation: Institute of Medical Biochemistry and Laboratory DiagnosticsFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Petr
authors.affiliation: Institute of Medical Biochemistry and Laboratory DiagnosticsFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic Fourth Department of Internal MedicineFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Libor
authors.initials: L
authors.lastname: Vítek
authors.affiliation: Department of DiabetesInstitute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Terezie
authors.initials: T
authors.lastname: Pelikánová
authors.affiliation: Institute of Medical Biochemistry and Laboratory DiagnosticsFirst Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic Department of ObesitologyInstitute of Endocrinology, Prague, Czech Republic mhalu@lf1.cuni.cz.
authors.forename: Martin
authors.initials: M
authors.lastname: Haluzík
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D001647:Bile Acids and Salts / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000378:metabolism* / Q000601:surgery; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005346:Fibroblast Growth Factors / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D011184:Postoperative Period; D019518:Postprandial Period; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001647:Bile Acids and Salts; D001786:Blood Glucose; C117476:FGF19 protein, human; D008055:Lipids; D005346:Fibroblast Growth Factors; D052216:Glucagon-Like Peptide 1
keywords: bile acids; duodenal–jejunal bypass liner; fibroblast growth factor 19; obesity; type 2 diabetes mellitus