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The Duodenal–Jejunal Bypass Liner for the Treatment of Type 2 Diabetes Mellitus and/or Obesity: a Systematic Review

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Abstract

This systematic literature review applies the GRADE approach to evaluate the efficacy and safety of the duodenal–jejunal bypass liner (DJBL) for the treatment of (a) patients with obesity ≥ grade II (with comorbidities) and (b) patients with type 2 diabetes mellitus + obesity ≥ grade I. We included ten studies with a total of 342 patients that primarily investigated a prototype of the DJBL. In high-grade obese patients, short-term excess weight loss was observed. For the remaining patient-relevant endpoints and patient populations, evidence was either not available or ambiguous. Complications (mostly minor) occurred in 64–100 % of DJBL patients compared to 0–27 % in the control groups. Gastrointestinal bleeding was observed in 4 % of patients. We do not yet recommend the device for routine use.

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References

  1. World Health Organization. Obesity and overweight. Factsheet no. 311. Updated in March 2013. 2013 [cited 2013 August 18]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/index.html

  2. International Diabetes Federation (IDF). IDF diabetes atlas 2013 [cited 2013 April 25]. Available from: http://www.idf.org/diabetesatlas/5e/diabetes

  3. Elmadfa I, Hasenegger V, Wagner K, et al. Österreichischer Ernährungsbericht 2012. Vienna: Institut für Ernährungswissenschaften; 2012.

  4. Hauner H, Buchholz G, Hamann B, et al. Prävention und Therapie der Adipositas 2007 [cited 2013 August 08]. Available from: http://www.dge.de/pdf/ll/Adipositas-Leitlinie-2007.pdf

  5. National Institute for Health and Clinical Excellence. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. London: National Institute for Health and Clinical Excellence; 2006.

    Google Scholar 

  6. Scottish Intercollegiate Guidelines Network. Management of obesity: a national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network; 2010.

    Google Scholar 

  7. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2013;36:S11–66.

    Article  Google Scholar 

  8. Scottish Intercollegiate Guidelines Network. Management of diabetes. Edinburgh: Scottish Intercollegiate Guidelines Network; 2010.

    Google Scholar 

  9. The Royal College of Physicians. Type 2 diabetes. National clinical guideline for primary and secondary care (update). London: The Royal College of Physicians; 2008.

    Google Scholar 

  10. ECRI Institute. AHRQ health care horizon scanning system—potential high-impact interventions report. Priority area 10: obesity. (Prepared by ECRI Institute under Contract No. HHSA290201000006C.). Rockville: Agency for Healthcare Research and Quality; 2012.

    Google Scholar 

  11. National Institute for Health and Clinical Excellence. Bariatric surgical service for the treatment of people with severe obesity. Commissioning guide. London: National Institute for Health and Clinical Excellence; 2007.

    Google Scholar 

  12. National Institute for Health and Clinical Excellence. Interventional procedure overview of implantation of a duodenal–jejunal bypass sleeve for managing obesity. London: National Institute for Health and Clinical Excellence; 2012.

    Google Scholar 

  13. Australian Government: Department of Health and Ageing. Horizon scanning technology prioritising summary. In: EndoBarrier Gastrointestinal Liner for obesity. Series horizon scanning technology prioritising summary. Commonwealth of Australia; 2010. p. 10.

  14. Gartlehner G. Internes manual. Abläufe und Methoden. Teil 2 (2nd Ed.). LBI-HTA Projektbericht 006 2008; (6):1–79.

  15. European Network for Health Technology Assessment (EUnetHTA). Endpoints used for relative effectiveness assessment of pharmaceuticals: clinical endpoints. Copenhagen: EUnetHTA; 2013.

  16. Bray G. Overview of therapy for obesity in adults 2013 [cited 2013 June 10]. Available from: http://www.uptodate.com/contents/overview-of-therapy-for-obesity-in-adults?source=search_result&search=obesity+treatment&selectedTitle=1%7E150#H11

  17. Jackson E, Rubenfire M. Obesity, weight reduction, and cardiovascular disease 2012 [cited 2013 June 10]. Available from: http://www.uptodate.com/contents/obesity-weight-reduction-and-cardiovascular-disease?source=search_result&search=voluntary+weight+loss&selectedTitle=6%7E150

  18. Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches. The GRADE Working Group. BMC Health Serv Res. 2004;4(1):38.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Gersin KS, Rothstein RI, Rosenthal RJ, et al. Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc. 2010;71(6):976–82.

    Article  PubMed  Google Scholar 

  20. Rodriguez L, Reyes E, Fagalde P, et al. Pilot clinical study of an endoscopic, removable duodenal-jejunal bypass liner for the treatment of type 2 diabetes. Diabetes Technol Ther. 2009;11(11):725–32.

    Article  CAS  PubMed  Google Scholar 

  21. Schouten R, Rijs CS, Bouvy ND, et al. A multicenter, randomized efficacy study of the EndoBarrier gastrointestinal liner for presurgical weight loss prior to bariatric surgery. Ann Surg. 2010;251(2):236–43.

    Article  PubMed  Google Scholar 

  22. Tarnoff M, Rodriguez L, Escalona A, et al. Open label, prospective, randomized controlled trial of an endoscopic duodenal–jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery. Surg Endosc. 2009;23(3):650–6.

    Article  CAS  PubMed  Google Scholar 

  23. Cohen RV, Galvao Neto MP, Correa J, et al. A pilot study of the duodenal–jejunal bypass liner in low body mass index type 2 diabetes. J Clin Endocrinol Metab. 2013;98(2):E279–82.

    Article  CAS  PubMed  Google Scholar 

  24. de Moura EGH, Orso IRB, Martins BC, et al. Improvement of insulin resistance and reduction of cardiovascular risk among obese patients with type 2 diabetes with the duodenojejunal bypass liner. Obes Surg. 2011;21(7):941–7.

    Article  PubMed  Google Scholar 

  25. de Moura EGH, Martins BC, Lopes GS, et al. Metabolic improvements in obese type 2 diabetes subjects implanted for 1 year with an endoscopically deployed duodenal–jejunal bypass liner. Diabetes Technol Ther. 2012;14(2):183–9.

    Article  PubMed  Google Scholar 

  26. Escalona A, Yanez R, Pimentel F, et al. Initial human experience with restrictive duodenal–jejunal bypass liner for treatment of morbid obesity. Surg Obes Relat Dis. 2010;6(2):126–31.

    Article  PubMed  Google Scholar 

  27. Escalona A, Pimentel F, Sharp A, et al. Weight loss and metabolic improvement in morbidly obese subjects implanted for 1 year with an endoscopic duodenal–jejunal bypass liner. Ann Surg. 2012;255(6):1080–5.

    Article  PubMed  Google Scholar 

  28. Rodriguez-Grunert L, Galvao Neto MP, Alamo M, et al. First human experience with endoscopically delivered and retrieved duodenal–jejunal bypass sleeve. Surg Obes Relat Dis. 2008;4(1):55–9.

    Article  PubMed  Google Scholar 

  29. Patel SR, Hakim D, Mason J, et al. The duodenal–jejunal bypass sleeve (EndoBarrier Gastrointestinal Liner) for weight loss and treatment of type 2 diabetes. Surg Obes Relat Dis 2013;9:482–4.

    Google Scholar 

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Acknowledgments

We would like to thank Tarquin Mittermayr for his thorough literature search. Furthermore, we are grateful to the participants of the European Network on Health Technology Assessment (EUnetHTA) for their comments on the review project ‘Duodenal–Jejunal Bypass Liner’ that was the basis for this article.

Grant Information

The paper is based on the project ‘EUnetHTA Joint Action 2’. EUnetHTA Joint Action 2 is supported by a grant from the European Commission (grant number 20112301). The sole responsibility for the content of this article lies with the authors, and the European Commission is not responsible for any use that may be made of the information contained therein. The views expressed in the article are the responsibility of the authors and do not necessarily reflect the views of EUnetHTA. EUnetHTA assumes no liability for the content or use thereof.

Conflict of Interest

Ingrid Zechmeister-Koss reports grants from European Union, DG Sanco, during the conduct of the study. Mirjana Huić reports grants from European Union, DG Sanco, during the conduct of the study. Stefan Fischer reports grants from European Union, DG Sanco, during the conduct of the study

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Authors and Affiliations

  1. Department of “Health Economics”, Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria

    Ingrid Zechmeister-Koss

  2. Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Planinska 13, 1000, Zagreb, Croatia

    Mirjana Huić

  3. Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria

    Stefan Fischer

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  1. Ingrid Zechmeister-Koss
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  2. Mirjana Huić
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  3. Stefan Fischer
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Correspondence to Ingrid Zechmeister-Koss.

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Zechmeister-Koss, I., Huić, M., Fischer, S. et al. The Duodenal–Jejunal Bypass Liner for the Treatment of Type 2 Diabetes Mellitus and/or Obesity: a Systematic Review. OBES SURG 24, 310–323 (2014). https://doi.org/10.1007/s11695-013-1137-2

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  • DOI: https://doi.org/10.1007/s11695-013-1137-2

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