Long-term effects of proximal small bowel exclusion by duodenal-jejunal bypass liner on weight reduction and glycemic control in diabetic patients

Background: Exclusion of the proximal gut from nutrient absorption entails significant metabolic benefits. The duodenal-jejunal bypass liner (DJBL) is the first endoscopic device that excludes the first part of the gut by covering it. Objectives: To assess weight and glycemic control at the end of treatment and after 1 year of follow-up. Setting: Bariatric endoscopy service in a tertiary medical center. Methods: Diabetic patients were treated with DJBL and followed prospectively between 2013 and 2016. Data were collected during scheduled visits. Results: Out of 51 patients treated, 39 completed at least 9 months with the device. Complications were recorded for the entire cohort. Percent of total weight loss was 15.05% ± 6.0% after 12 months of treatment (P <.001 versus baseline). Twelve months postretrieval, percent of total weight loss decreased to 8.75% ± 5.07% (P <.001 versus baseline). Patients with baseline body mass index ≥35 kg/m² experienced greater percent total weight loss changes over time (P <.001). There was a significant effect on hemoglobin A1C levels over time (P =.003), and the nadir was reached at 9 months of treatment (median 6.05% versus 7.20% at baseline, P <.001). Insulin users had consistently higher median hemoglobin A1C values compared with insulin nonusers (P <.001). Adverse events were experienced by 12 of 51 patients (23.5%), of which 4 cases (7.8%) were severe. Conclusions: Proximal bowel bypass by DJBL is an effective tool for weight reduction and glycemic control. Metabolic achievements are partially preserved at 1 year after device removal. Because DJBL entails a considerable rate of side effects, strategies to mitigate them are warranted.