Glycemic And Hepatic Outcomes After Endoscopic Duodenal Mucosal Resurfacing: A Systematic Review And Meta-Analysis

Aims Duodenal mucosal resurfacing (DMR) is a groundbreaking endoscopic bariatric and metabolic therapy (EBMT). It is an upper endoscopic procedure that, using a catheter, performs mucosal ablation in postpapillary duodenum to achieve better glycemic control. This study aimed to evaluate the glycemic and hepatic effects of this new procedure.

Methods Only studies evaluating the Revita duodenal mucosal resurfacing procedure (Fractyl Laboratories) device were included. Electronic searches were performed using the Medline (PubMed), LILACS, Cochrane Library, and EMBASE databases, from inception to November, 2020. The primary outcome measurement in this study was the effectiveness of the DMR procedure. Defined by the change in metabolic parameters at 3 and 6 months post-procedure, including changes in HbA1C levels, fasting plasma glucose (FPG), liver enzymes or reduction on hepatic steatosis as measured by magnetic resonance imaging derived proton-density-fat-fraction (MRI-PDFF).

Results Based upon this study including 127 patients from 4 studies. There were great changes in glycemic parameters at 3 and 6 months, post-DMR. At 3 months after the procedure was observed a HbA1C decrease of 1.72 % [(95 % CI, 0.25 to 3.19); P = 0.020]. HbA1C decreased 0.94 %, [(95 % CI, 0.68 to 1.21) P < 0.001] after 6 months of DMR. FPG was improved, 15.84 mg/dL drop [(95 % CI, 2.91 to 28.77); P = 0.020] after 6 months. ALT levels were noted to significantly improve at both 3 and 6 months post-procedure. With a reduction of 10.48 U/L [(95 % CI, 8.75 to 12.22); P < 0.001] after 3 months which persisted at 6 months 10.82 U/L [(95 % CI, 4.80 to 16.84); P < 0.001]. After 3 months of DMR a 6.59 % reduction in liver fat was noted [(95 % CI, 5.05 to 8.12); P < 0.001] when evaluated by MRI-PDFF.

Conclusions The currently available data suggests that DMR may be used as an alternative treatment for short-term glycemic control and to reduce hepatic steatosis in non-insulin-dependent patients with sub-optimal control T2D.

Citation de Oliveira GHP, de Moura DTH, McCarty TR et al. eP472 GLYCEMIC AND HEPATIC OUTCOMES AFTER ENDOSCOPIC DUODENAL MUCOSAL RESURFACING: A SYSTEMATIC REVIEW AND META-ANALYSIS. Endoscopy 2021; 53: S253.

Publication History

Article published online:
19 March 2021