Changes in glycemic control and body weight after explantation of the duodenal-jejunal bypass liner

• Published in: Gastrointestinal endoscopy 2017-02, Vol.85 (2), p.409-415
• Main Authors: Betzel, Bark, MD, Koehestanie, Parviez, MD, Homan, Jens, MD, Aarts, Edo O., MD, PhD, Janssen, Ignace M.C., MD, de Boer, Hans, MD, PhD, Wahab, Peter J., MD, PhD, Groenen, Marcel J.M., MD, PhD, Berends, Frits J., MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Bariatric Surgery; Blood Glucose - metabolism; Blood Pressure; Body Weight; Device Removal; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Duodenum - surgery; Female; Gastroenterology and Hepatology; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Jejunum - surgery; Male; Middle Aged; Obesity - metabolism; Obesity - surgery; Prospective Studies; Weight Gain
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2016.07.027

Background and Aims The duodenal-jejunal bypass liner (DJBL) is an endoscopic device that induces weight loss and improves glycemic control in patients with type 2 diabetes mellitus (T2DM). The aim of the current study was to assess the effects of DJBL explantation on glycemic control and body weight. Methods This prospective, observational study included only patients with T2DM who had the DJBL implanted for at least 6 months and had a follow-up of at least 12 months after explantation. The primary endpoints were changes in glycosylated hemoglobin A1c (HbA1c ) and body weight during the 12 months after explantation. Secondary endpoints were changes in fasting plasma glucose, blood pressure, and plasma lipid levels. Results In total, 59 patients completed the 12-month follow-up after explantation. During this period body weight increased by 5.6 (standard deviation, 6.4) kg ( P  < .001) and HbA1c rose from 65 (SD 17) to 70 (SD 20) mmol/mol ( P  < .001). However, body weight remained 8.0 (SD 8.6) kg ( P  < .001) lower than before implantation, that is, corresponding to a net total body weight loss of 7.4% (SD 7.6) ( P  < .001). Although HbA1c was significantly higher 12 months after explantation compared with baseline and the mean daily dose of insulin used was comparable, the number of patients on insulin remained significantly lower than before implantation. Conclusions Explantation of the DJBL is associated with weight gain and worsening of glycemic control, although some beneficial effects remained detectable 12 months after explantation. A change in strategy is needed to preserve the beneficial effects of DJBL treatment. (Clinical trial registration number: 746∖100111.)