Review article
The duodenal-jejunal bypass sleeve (EndoBarrier Gastrointestinal Liner) for weight loss and treatment of type 2 diabetes

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Abstract

Background

Surgical intervention is now the most effective modality with which to treat severe obesity. There is currently a lack of minimally invasive technology with which we can effectively treat obesity and reverse type 2 diabetes mellitus. The EndoBarrier is a fluoropolymer sleeve that is reversibly fixated to the duodenal bulb and extends 80 cm into the small bowel, usually terminating in the proximal jejunum. This endoscopically inserted device aids weight loss through malabsorption and activating hormonal triggers.

Methods

We conducted a nonsystematic review on worldwide articles published on the MEDLINE database to ascertain progress in the development and use of the EndoBarrier.

Results

Most studies used 12-week excess weight loss (EWL) as a primary outcome measure with results ranging from 11.9%–23.6%. One study to date used 52-week EWL as its primary measure with a significant outcome of 47%. Our group has seen this technology cause significant weight loss, resolution of type 2 diabetes mellitus, and improvement in cardiovascular risk factor profile.

Conclusions

The EndoBarrier shows promise in the surgical weight loss arena. This review article summarizes the technical aspects of this new technology, provides preliminary efficacy results, and introduces the roles it may play in the future of bariatric surgery.

Section snippets

The duodenal-jejunal bypass sleeve

The duodenal-jejunal bypass sleeve (DJBS, EndoBarrier Gastrointestinal Liner; GI Dynamics Inc., Lexington, MA) is an endoscopically and fluoroscopically inserted implant (Fig. 1). It is an impermeable fluoropolymer sleeve that is reversibly fixated to the duodenal bulb and extends 80 cm into the small bowel, usually terminating in the proximal jejunum [3]. It allows transit of chyme from the stomach through to the jejunum without contact with the duodenal wall. Biliary and pancreatic fluids

Efficacy and safety

As would be expected for a technology in its infancy, there are only a handful of reported series regarding the use of the EndoBarrier in the literature (Table 1). They have all used excess weight loss (EWL) as their primary outcome measure. The first reported human case series was by Rodriguez et al. in 2008, which reported a 12-week EWL of 23.6% [5]. Four other studies, which are also shown in Table 1, have completed trials with the EndoBarrier in a randomized fashion against either sham

The future

The first series published on the use of the EndoBarrier uncovered a resolution of type 2 diabetes mellitus in 3 of 4 affected patients [5]. Interestingly, there was no difference in weight loss between diabetic and nondiabetic patients. This, therefore, brought up the possible role of the EndoBarrier in treating type 2 diabetes mellitus independently of weight loss. This notion has been substantiated this year by a team in Brazil that carried out an investigation into the use of the

Conclusion

The duodenal-jejunal bypass sleeve is the first endoluminal device to effectively cause weight loss through malabsorption in obese individuals. Its use is associated with difficulties regarding implantation as well as complications requiring early extraction. These will be reduced with increased use of the device. The application of the device in reported studies have primarily used 12-week EWL as a primary endpoint, so, at this stage, one must consider it only as a method of inducing temporary

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (9)

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