Effects of Duodenal-Jejunal Bypass Liner (EndoBarrierA (R)) on Gastric Emptying in Obese and Type 2 Diabetic Patients

Abstract

The duodenal-jejunal bypass liner (DJBL) is a promising technique for treating obesity and type 2 diabetes mellitus (T2DM). However, despite promising results, its mechanism of action has not been elucidated. It is thought to promote changes in gastric emptying owing to the neuro-endocrine axis. The aim of this paper was to study DJBL-induced changes in gastric emptying and the relationship of those changes with weight loss and T2DM. Twenty-five patients with obesity and T2DM met inclusion criteria. Scintigraphic gastric emptying testing was performed prior to implantation, 16 weeks after implantation, and 4 weeks after removal. The average gastric retention was compared between tests, to examine the relationship between gastric emptying and those who lost more than 10 % of total body weight. Similarly, we compared average gastric retention between those who achieved a glycated hemoglobin target lower than 7 %. Average gastric retention was greater after DJBL implantation compared with the baseline (first hour, 74 +/- 16.3 %, p = 0.001; second hour, 45 +/- 25 %, p < 0.001; fourth hour, 15.8 +/- 15 %, p < 0.001). There was no difference between the baseline and 4 weeks after device removal (fourth hour, p = 0.057). Gastric retention was similar between patients who achieved T2DM control and those who did not (p = 0.73). Additionally, no difference was seen between patients who lost more than 10 % of body weight and those who did not (p = 0.275). DJBL delays gastric emptying but is reversible after withdrawal. The changes in gastric emptying have no relationship to weight loss and T2DM control.