Histologic assessment of the intestinal wall following duodenal mucosal resurfacing (DMR): a new procedure for the treatment of insulin-resistant metabolic disease

Eduardo G. H. de Moura; Alberto M. Ponte-Neto; Anastasia Tsakmaki; Vera Demarchi Aiello; Gavin A. Bewick; Vitor O. Brunaldi

doi:10.1055/a-0862-0263

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(05): E685-E690
DOI: 10.1055/a-0862-0263

Original article

Histologic assessment of the intestinal wall following duodenal mucosal resurfacing (DMR): a new procedure for the treatment of insulin-resistant metabolic disease

Eduardo G. H. de Moura

¹Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil

,

Alberto M. Ponte-Neto

¹Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil

,

Anastasia Tsakmaki

²Diabetes Research Group, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK

,

Vera Demarchi Aiello

³Laboratory of Pathology, Hearth Institute (InCor), Hospital das Clínicas da Faculdade de Medicine da Universidade de São Paulo, Brazil

,

Gavin A. Bewick

²Diabetes Research Group, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK

,

Vitor O. Brunaldi

¹Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil

› Author Affiliations

Abstract

Background and study aims Minimally invasive procedures that replicate aspects of bariatric surgery with more favorable safety and tolerability offer an attractive alternative in management of metabolic disease. Duodenal mucosal resurfacing (DMR), an endoscopic procedure using hydrothermal ablation, is designed to remove surface epithelium to allow subsequent epithelial regeneration and a reset to a more insulin-sensitive state.

Materials and methods DMR was performed on a healthy pig under general anethesia, approximating the procedure designed for use in humans. Immediately post-DMR, analysis of the histological landscape was conducted in distinct duodenal areas that received ablation treatment.

Results DMR submucosal lift and hydrothermal ablation elicited disruption of villous tips and partial disruption of the crypt base with no damage to deeper tissue. Excessive ablation (purposeful double ablation exposure) did incur damage to the underlying muscle layer.

Conclusion Our results confirmed that DMR elicits superficial ablation of duodenal villi and crypts. Defining the cellular consequences of ablation and regeneration of the epithelium will aid our understanding of how and why DMR affects metabolic homeostasis.

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References

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