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RYGB vs EndoBarrier for T2DM remission
The first study comparing the improvement in glucose metabolism following roux-en-y gastric bypass (RYGB) surgery to the less invasive endoscopic placement of a duodenojejunal bypass liner (DJBL, the EndoBarrier device) has found that although RYGB was superior by inducing weight loss, both procedures have a similar impact on diabetes remission, indicating that alteration of weight loss itself is not the main determinant of improvement in glucose homeostasis in these obesity procedures.
The preliminary data was presented in a poster titled, ‘Improvement in Glucose Metabolism after Bariatric Surgery: Comparison of Laparoscopic Roux-en-Y Gastric Bypass and Duodenojejunal Bypass,’ by Dr Jürgen Stein, Department of Gastroenterology and Clinical Nutrition, Hospital Sachsenhausen, Frankfurt, Germany, at the American Gastroenterological Association’s annual Digestive Disease Week (DDW) meeting in Washington, DC.
The study included 37 patients with 17 (3 male, mean age 50.8±11,8yrs; body weight 126.1±21.9kg; BMI45.0±6.8, HbA1c, 7.4±1.0%) receiving a RYGB and 20 patients the DJBL (six male, mean age 52.7±10,8yrs, body weight 116.4±28.0; BMI39.9±7.4; HbA1c, 9.2±1.6%). Body weight, BMI and glycated haemoglobin A1C (HbA1C) were documented one, three and nine months following each procedure.
Compared to pre-intervention both procedures resulted in a significant improvement of body weight, BMI and metabolic parameters: RYGB (body weight – 28.2 kg; HbA1c, -1.1%, BMI –10.4) and DJBL (body weight – 22.9 kg; HbA1c, -1.4%; BMI – 8.8).
According to the company, the data show that EndoBarrier - specifically designed to mimic the duodenal-jejunal exclusion created by gastric bypass surgery - has a significant impact on glucose homeostasis at one, three and nine months of therapy, which can reduce the reliance patients may have on diabetes medications.
“It is interesting to observe how EndoBarrier treatment compares to bariatric surgery when administered at the same clinical center in the hands of independent researchers,” said Dr David Maggs, chief medical officer of GI Dynamics. “This is another important milestone that manifests the potential for device intervention while avoiding the alteration of anatomy by surgery.”