Weight reduction and improvement in diabetes by the duodenal-jejunal bypass liner: a 198 patient cohort study.
The duodenal-jejunal bypass liner (DJBL) is an endoscopic treatment for patients with type 2 diabetes mellitus (T2DM) and (morbid) obesity. The aim of the current study was to determine its efficacy and safety profile.



Inclusion criteria for treatment with a DJBL were: age 18-70 years, BMI 28-45 kg/m2, and T2DM with a HbA1c > 48 mmol/mol. Primary outcomes were changes in HbA1c and body weight. Secondary outcomes included changes in blood pressure, lipids, and anti-diabetic medication. Predictive factors for success of treatment with the DJBL were determined.



Between 2011 and 2014, 185 out of 198 patients successfully underwent a DJBL implantation procedure, with an intended implantation time of 12 months. In these 185 patients, body weight decreased by 12.8 ± 8.0 kg (total body weight loss of 11.9 ± 6.9 %, p < 0.001), HbA1c decreased from 67 to 61 mmol/mol (p < 0.001) despite a reduction in anti-diabetic medication, and blood pressure and serum lipid levels all decreased. In total, 57 (31 %) DJBLs were explanted early after a median duration of 33 weeks. Adverse events occurred in 17 % of patients. C-peptide ≥1.0 nmol/L and body weight ≥107 kg at screening were independent predictive factors for success.



Treatment with the DJBL in T2DM patients with (morbid) obesity results in improvement in glucose control, a reduction in anti-diabetic medication, and significant weight loss. The largest changes are observed within the first 3-6 months. Initial C-peptide levels and body weight may help to select patients with the greatest chance of success.
Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800 TA, Arnhem, The Netherlands. bbetzel@rijnstate.nl.
Bark
B
Betzel
Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800 TA, Arnhem, The Netherlands.
Jens
J
Homan
Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800 TA, Arnhem, The Netherlands.
Edo O
EO
Aarts
Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800 TA, Arnhem, The Netherlands.
Ignace M C
IMC
Janssen
Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
Hans
H
de Boer
Department of Gastroenterology, Rijnstate Hospital, Arnhem, The Netherlands.
Peter J
PJ
Wahab
Department of Gastroenterology, Rijnstate Hospital, Arnhem, The Netherlands.
Marcel J M
MJM
Groenen
Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800 TA, Arnhem, The Netherlands.
Frits J
FJ
Berends
D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000295:instrumentation / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D019736:Prostheses and Implants; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
(Morbid) obesity; Adverse events; Duodenal-jejunal-bypass liner; EndoBarrier; Type 2 diabetes