The list of mechanical options to lose weight is now a bit longer. In addition to cutting, banding and ballooning, we also have lining. The duodenal-jejunal bypass liner (DJBL), commercially referred to as the EndoBarrier Gastrointestinal Liner, is an impermeable sleeve that is inserted through the mouth to line the upper part of the small intestine (the duodenum and first part of the jejunum). The sleeve non-invasively mimics the effect of the Roux-en-Y gastric bypass procedure.
It is thought to act by creating a physical barrier that prevents ingested food from being absorbed through the intestinal wall. It may also alter hormonal activation (e.g., incretin) in the gut. The liner is put into place via an outpatient procedure that takes about 30 minutes. It is usually recommended that it remain in place for 4-6 months, however, Dr. Charlotte de Jonge of Maastricht University Medical Centre in the Netherlands has be quoted as saying “the device could be used for up to two years in some patients. The liner is removed in an outpatient procedure that supposedly takes only 15 minutes. Voila – easy in and easy out and the best part….no scar!
Here is a video to show you how it is done (in a pig):
A recent study, reported at the Annual Meeting of the European Association for the Study of Diabetes, showed that not only did individuals treated with the sleeve lose weight, they also improved their glucose parameters, such as hemoglobinA1c, they also had improved their hormone profiles (increased levels of glucagon-like peptide (GLP-1), peptide YY, and incretin). There were only 17 people in the study and there was no control group so it remains to be seen if these results hold up. Also, the study was relatively short (24 weeks) so we don’t know from this study whether the improvements are sustainable.
Two other small studies presented at the 29th Annual Scientific Meeting of the Obesity Society shed some light on the question of sustainability. In a prior study by a group in Sao Paolo, Brazil, 22 patients with type 2 diabetes were treated with the EndoBarrier GI Liner for 12 months with a mean weight loss of 20.2 kilograms (~45 pounds!). Their hemoglobin A1c improved by 2.3% and glucose levels fell from an average of 175 prior to the sleeve to 138 after insertion of the sleeve. More recent data on this group showed that 6 months after the sleeve was removed the patients had a negligible increase in HbA1c from 6.5% to 6.6%. Another small study, this one in Santiago, Chile showed that 22 patients who completed 12 months of treatment with the sleeve were able to maintain as much as 75% of the weight they lost as a result of the sleeve.
This is good news indeed. If larger trials, particularly ones with a control group, confirm these results we will now have another arrow in the weight loss/type 2 diabetes quiver.