Exp Clin Endocrinol Diabetes 2014; 122 - P099
DOI: 10.1055/s-0034-1372116

Endoscopic Duodenal-Jejunal Bypass Liner (EndoBarrier®) for the treatment of type 2 diabetes mellitus

K Laubner 1, N Perakakis 1, L Potasso 1, H Schwacha 2, J Seufert 1
  • 1University Hospital of Freiburg, Internal Medicine II, Endocrinology/Diabetology, Freiburg, Germany
  • 2University Hospital of Freiburg, Internal Medicine II, Gastroenterology, Freiburg, Germany

Background: Improvement of type 2 diabetes occurs independent of weight-loss after bariatric surgery that excludes the proximal small intestine, and is to a major part the result of increased incretin levels. The duodenal-jejunal bypass liner (DJBL) is an endoscopically delivered and removable device creating a duodeno-jejunal bypass thereby mimicking Roux-en-Y and Duodenal-Jejunal Bypass procedures. The DJBL is indicated for the treatment of type 2 diabetes and obesity. Here we report interim results of the ongoing data collection of 26 patients treated by this procedure.

Methods: Since August 2012, 26 subjects with type 2 diabetes (f: m 20: 6; mean age 46,0 y) on various medications, a mean baseline HbA1c of 7,7% and a mean BMI of 44,7 kg/m2 were implanted with a DJBL. Adverse events as well as anthropometric, metabolic and cardiovascular risk parameters were monitored every 3 months. After 12 months the DJBL was removed.

Results: In comparison to baseline, HbA1c was reduced from 7,7% to 6,7% (subjects with HbA1c at baseline > 7,0% from 8,9% to 7,3%). Antidiabetic medication could also be substantially reduced. Mean BMI was reduced to 38,5 kg/m2, corresponding to an EWL of 24,5%. LDL decreased from 109,4 mg/dl to 97 mg/dl. Parameters of NAFDL decreased as follows: GPT from 46,3 to 38,7 U/I, GGT from 74,2 to 49,5 U/I. The most common complications were abdominal pain and nausea especially in the first two weeks after implantation. We observed one duodenal perforation as a serious complication. The DJBL was removed preemptively in 5 subjects (due to abdominal pain, migration).

Conclusion: The DJBL is a safe and effective endoscopic device which improves glycemic control, body weight and related metabolic and cardiovascular risk-parameters in obese type 2 diabetes patients. Individual response to the DJBL is variable, and depends on subject compliance. The DJBL may represent an alternative or adjunct to bariatric surgery to treat diabetes mellitus type 2 and obesity.