Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1683-E1689
DOI: 10.1055/a-1244-2283
Original article

Duodenal mucosal resurfacing: Multicenter experience implementing a minimally invasive endoscopic procedure for treatment of type 2 diabetes mellitus

Annieke C.G. van Baar
 1   Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
,
Rehan Haidry
 2   Gastroenterology, University College Hospital, London, UK
,
Leonardo Rodriguez Grunert
 3   CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
,
Manoel P. Neto Galvao
 4   Bariatric Endoscopy service, Endovitta Institute, Sao Paulo, Brazil
 5   Surgery, FMABC Medical School, Sao Paulo, Brazil
,
Raf Bisschops
 6   Gastroenterology and Hepatology, Catholic University of Leuven, Leuven, Belgium
,
Bu Hussain Hayee
 7   Institute of Therapeutic Endoscopy, King’s Health Partners, London, UK
,
Guido Costamagna
 8   Digestive Endoscopy, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
 9   CERTT (Centre for Endoscopic Research Therapeutics and Training), Università Cattolica, Rome, Italy
,
Jacques Deviere
10   Gastroenterology, Erasme University Hospital, Brussels, Belgium
,
Jacques J.G.H.M. Bergman
 1   Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Duodenal mucosal resurfacing (DMR) is an endoscopic procedure which improves insulin resistant metabolic disease, including type 2 diabetes mellitus (T2DM). The aim of this report was to evaluate the feasibility and procedural aspects of DMR and to provide more specific DMR procedural guidance for endoscopists.

Patients and methods In this international multicenter, prospective, open-label study, patients on oral anti-diabetic agents for treating T2DM underwent single DMR. DMR entails circumferential submucosal lifting followed by circumferential mucosal hydrothermal ablation using an over-the-guidewire balloon catheter for lifting and ablation. For the first 28 patients a dual catheter system was used. During the study, a new integrated catheter was developed which was used for the latter 18 patients. During DMR, procedure success (complete DMR: duodenal ablation length ≥ 9 cm) and procedure duration were captured.

Results Forty-six patients underwent DMR. Using the dual catheter system, a complete DMR was performed in 22 of 28 patients (79 %). In the next eighteen patients who underwent DMR with the integrated catheter, a complete DMR was performed in 15 of 18 patients (83 %). The integrated catheter facilitated the DMR procedure and resulted in a reduction in procedure time. A detailed table and video are provided for future endoscopists.

Conclusions In our multicenter study, DMR was found to be feasible in the hands of experienced endoscopists. The integrated DMR catheter was a welcome modification during the study, allowing for easier ablation administration. Further optimization of the technique would be valuable prior to widespread dissemination.



Publication History

Received: 14 July 2020

Accepted: 30 July 2020

Article published online:
22 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2020; 52(12): 1151-1151
DOI: 10.1055/a-1256-4050

 

  • References

  • 1 da Rocha Fernandes J, Ogurtsova K, Linnenkamp U. et al. IDF Diabetes Atlas estimates of 2014 global health expenditures on diabetes. Diabetes Res Clin Practice 2016; 117: 48-54
    CrossrefPubMedGoogle Scholar
  • 2 Wong K, Glovaci D, Malik S. et al. Comparison of demographic factors and cardiovascular risk factor control among U.S. adults with type 2 diabetes by insulin treatment classification. J Diabetes Complications 2012; 26: 169-174
    CrossrefPubMedGoogle Scholar
  • 3 van Baar ACG, Nieuwdorp M, Holleman F. et al. The duodenum harbors a broad untapped therapeutic potential. Gastroenterology 2018; DOI: 10.1053/j.gastro.2018.02.010.
    CrossrefPubMedGoogle Scholar
  • 4 Rubino F, Forgione A, Cummings DE. et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surgery 2006; 244: 741-749
    CrossrefPubMedGoogle Scholar
  • 5 Pories WJ, Albrecht RJ. Etiology of type II diabetes mellitus: role of the foregut. World J Surgery 2001; 25: 527-531
    CrossrefPubMedGoogle Scholar
  • 6 Salinari S, Carr RD, Guidone C. et al. Nutrient infusion bypassing duodenum-jejunum improves insulin sensitivity in glucose-tolerant and diabetic obese subjects. Am J Physiol Endocrinol Metabol 2013; 305: E59-E66
    CrossrefPubMedGoogle Scholar
  • 7 Dirksen C, Hansen DL, Madsbad S. et al. Postprandial diabetic glucose tolerance is normalized by gastric bypass feeding as opposed to gastric feeding and is associated with exaggerated GLP-1 secretion: a case report. Diabetes Care 2010; 33: 375-377
    CrossrefPubMedGoogle Scholar
  • 8 Betzel B, Koehestanie P, Homan J. et al. Changes in glycemic control and body weight after explantation of the duodenal-jejunal bypass liner. Gastrointest Endosc 2017; 85: 409-415
    CrossrefPubMedGoogle Scholar
  • 9 Haidry RJ, van Baar AC, Galvao NetoMP. et al. Duodenal mucosal resurfacing: proof-of-concept, procedural development, and initial implementation in the clinical setting. Gastrointest Endosc 2019; DOI: 10.1016/j.gie.2019.03.024.
    CrossrefPubMedGoogle Scholar
  • 10 van Baar ACG, Beuers U, Wong K. et al. Endoscopic duodenal mucosal resurfacing improves glycaemic and hepatic indices in type 2 diabetes: 6-month multicentre results. JHEP Rep 2019; 1: 429-437
    CrossrefPubMedGoogle Scholar
  • 11 van Baar ACG, Holleman F, Crenier L. et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study. Gut 2020; 69: 295-303
    CrossrefPubMedGoogle Scholar
  • 12 Rajagopalan H, Cherrington AD, Thompson CC. et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes: 6-month interim analysis from the first-in-human proof-of-concept study. Diabetes Care 2016; 39: 2254-2261
    CrossrefPubMedGoogle Scholar