PWE-070 The Duodenal-Jejunal Bypass Sleeve (Endobarrier Gastrointestinal Liner) For Weight Loss and Treatment of Type Ii Diabetes
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Abstract:
Introduction
The Duodenal–jejunal bypass sleeve (EndoBarrier Gastrointestinal Liner) is an endoscopically and fluoroscopically inserted implant designed to aid weight loss, treat type II diabetes mellitus and improve the cardiovascular risk profile of subjects. We aimed to trial this device in a cohort of patients to assess efficacy.Methods
We implanted the EndoBarrier bypass sleeve into 57 patients from January 2011 to December 2012. The EndoBarrier is an impermeable fluoropolymer sleeve that is reversibly fixated to the duodenal bulb and extends 80cm into the small bowel, usually terminating in the proximal jejunum. It is implanted in the GI tract endoscopically to create a barrier between food and the wall of the intestine and to delay the mixing of digestive enzymes with food. It alters the activation of hormonal signals that originate in the intestine, thus mimicking the effects of a Roux-en-Y gastric bypass procedure without surgery.Results
Results showed weight loss in all patients, as well as lowering of blood sugar levels. Only 1 early device removal (due migration) occurred. There were no major postoperative side effects.Conclusion
Results confirm that the device reduces blood sugar levels and triggers weight loss. This non-permanent device implanted and removed endoscopically, controlled blood sugar and weight loss without the trauma of surgery. Clinical trials to date, involving more than 300 patients, have demonstrated significant weight loss and diabetes improvement with the Endobarrier. However, since this is a new procedure and due to the lack of data, it is not yet known if weight loss and diabetes benefits will persist.Disclosure of Interest
None Declared.Keywords:
Duodenal bulb
Jejunum
Weight management
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Eight groups of Alpine Fine-wool lambs were used to study the development of pH and five enzyme activities in duodenum, proximal jejunum, middle jejunum, distal jejunum, and ileum mucosa or digesta from birth to d56.From duodenum to ileum the acdity of intestinal mucosa and digesta decreased. pH changed in a very little range in all small intestine with age.The trypsin,chymotrypsin, lipase, lactase, and α-amylase activities were observed at birth but decreased at d3.Thereafter they showed a non-uniform change pattern in different parts. From d 3 to 21 the trypsin activity tended to increase and reached peak at d21,thereafter it began to decrease In duodenum, proximal jejunum and middle jejunum. In distal jejunum and ileum it reached peak at d 7. From d 14 to 28 the chymotrypsin activity increased charply and reached peak at d 28 in duodenum.The gradual nonsignificant increases were abserved from d 3 to 56 in proximal jejunum.From d 3 to 21 the chymotrypsin activity increased and reached peak at d 21 in middle jejunum digesta,thereafter it tended to decrease.In distal jejunum the chymotrypsin activity increased from d 3 to 14 ,d 28 to 56 and decreased from d 14 to 28.And reached peak at d 14 and 56 respectively.In ileum it tended to increase with age and at d21 it had a sharply increase. The chymotrypsin activity in duodenum and proximal jejunum digesta was lower than that in other parts,and it was the highest in middle jejunum. The lipase activity of small intestinal mucosa changed little with age.In duodenum mucosa lipase activity was the highest and pre-jejunum was lowest.In all small intestinal mucosa α-amylase activity was near at birth. Duodenum and proximal jejunum was a little low.At 3d α-amylase activity in the two parts mucosa was close to birth, and increased at 7d or 14d respectively.After 21d α-amylase activity in duodenum mucosa was the highest,followed middle jejunum mucosa, and in ileum mucosa it seemed to be the lowest.The lactase activity was high at birth and decreased at 21d.It was the highest in proximal- and midddle-jejunum mucaosa,but lowest in ileum mucosa.The activity changed little in duodenum mucosa,but decreased with age in other parts.
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The i.p. administration of a single dose (10 kg) of lead chloride (PbClJ to male adult rats significantly decreased (P < 0.05) liver ight after 72 h. Lead significantly increaT sed the concentration of total thiols (ToThi) in duodenum and jejunum as well as that of non-protein thiols (NpThi) in jejunum 30 mih after its administration. However, as early as 10 min after administration, lead significantly decreased the activities of the following: a) y-glutamyl transpeptidase (GTP) in liver (60 2 7%), kidneys (26 +- 4%) and jejunum (61 +- 6%); b) alanylaminopeptidase (AAP) in kidneys (27 2 5%) and jejunum (64 2 5%); c) carboxylesterases/amidases (CE/A) in liver (32 ? 3%) and jejunum (47 2 5%); d) glutathione-S-transferase (GST) in liver (49 2 3%), kidneys (51 2 5%) and jejunum (54 2 3%); and d) butyrylcholinesterase (BChE) in jejunum (67 + 4%). Some of lead's effects on the enzymes studied were not detected after 30 min but reappeared 24 and 72 h after lead administration. When taken together, these results indicate that jejunum and liver are the organs in adult rats most susceptible to a single, low dose of PbC1, when it is i.p. administered.
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The posteriorly directed duodenal bulb can be difficult to demonstrate because of the overlapping gastric antrum. A technique is described for displacing the antrum from the bulb while simultaneously distending the barium-coated duodenal bulb with air.
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The patchy nature of villous lesion in celiac disease is increasingly being recognized. Current guidelines recommend four endoscopic duodenal mucosal biopsies from the second or more distal part of the duodenum to confirm the diagnosis of celiac disease. The purpose of the study was to investigate the usefulness of duodenal bulb mucosal biopsies in confirming the diagnosis of celiac disease in everyday clinical practice. All patients with a positive tissue-transglutaminase antibody requiring biopsy-confirmation of celiac disease over a two-year period were studied. Two endoscopic biopsies were taken from the duodenal bulb and four biopsies from the second (or distal) part of the duodenum. Thirty-five patients were included, mean age 8.1 (± 4.7) years. Thirty-one (88.6%) patients had abnormal distal duodenal biopsies, one had Marsh type 1, one had Marsh type 2 and twenty-nine had Marsh type 3 lesion. All but two patients with abnormal distal duodenal biopsies also had abnormal bulb biopsies. Four (11.4%) patients had normal distal duodenal biopsies but abnormal bulb biopsies. Of these, one patient had Marsh type 2 and three had Marsh type 3 lesion. The distal duodenum was also grossly normal in these four patients. The histological diagnosis of celiac disease would not have been possible in these four cases with distal duodenal biopsies only. The lesion in celiac disease in children can be patchy with duodenal bulb mucosa being the only area showing histological changes. The recommendations regarding the site of biopsies should be revised to include biopsies not only from distal duodenum but also from bulb to improve the diagnostic yield.
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A 49-year-old woman with Gardner's syndrome, who underwent total proctocolectomy in 1982, was found to have a cancer of the duodenal bulb. Subsequently, resection of the stomach and duodenal bulb was performed in 1983. The surgical specimen showed an ulcerating tumor in the duodenal bulb which was a moderately differentiated adenocarcinoma histologically. Multiple adenomas were present in the gastric antrum and the duodenum. Duodenal cancer so far reported has been mostly confined to the periampullary region, and cancer of the duodenal bulb associated with familial polyposis coli has not been reported.
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We report a case of lipoma in the antrum of the stomach which prolapsed into the duodenal bulb and caused a duodenal ulcer, which was speculated to have been induced by the friction of its tip against the duodenal mucosa. Although the duodenal ulcer healed after the administration of a proton pump inhibitor, the symptoms of epigastric discomfort continued, which was suggested to be due to the prolapse. Therefore, a laparoscopic operation was conducted. The incidence of lipoma of the stomach is rare, and cases of its prolapse into the duodenum are few. Furthermore, it is extremely rare for it to cause a duodenal ulcer. Because these features made this case clinically interesting, we report it here.
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Multiple polypoid filling defects of the duodenal bulb are infrequently encountered. Two cases of multiple filling defects of the duodenal bulb are reported in this paper.Case 1. A 42 year old female complained of abdominal fullness and epigastralgia. On examination, generalized peripheral lymphadenopathy and marked hepatosplenomegaly were noted. Cervical lymphnode biopsy revealed a diffuse, poorly-differanciated lymphocytic lymphoma. X-ray examination of the gastrointestinal tract showed multiple filling defects localized at the duodenal bulb. Endoscopy disclosed multiple well-defined protrusions with small mucosal ulceration over the the whole circumference of the duodenal wall.Case 2. A 36 year old female had no subjective symptoms. At gastric mass screening, numerous polypoid elevations of the duodenal bulb were pointed out. Detailed gastrointestinal x-ray examination showed numerous, tiny, round polypoid nodules localized at the duodenal bulb. These nodules were 2-3 mm in size with no mucosal ulceration. The endoscopic biopsy specimen revealed lymphoid hyperplasia of the duodenal bulb.
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