Download PDF
Horm Metab Res 2016; 48(10): 630-637
DOI: 10.1055/s-0042-115175
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Beneficial Metabolic Effects of Duodenal Jejunal Bypass Liner for the Treatment of Adipose Patients with Type 2 Diabetes Mellitus: Analysis of Responders and Non-Responders

B. Stratmann   *
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
Y. Krepak   *
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
E. Schiffer
2   Numares AG, Regensburg, Germany
,
I. Jarick
2   Numares AG, Regensburg, Germany
,
M. Hauber
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
Y. H. Lee-Barkey
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
M. Fischer
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
,
D. Tschoepe
1   Herz und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
› Author Affiliations
Further Information

Publication History

received 05 February 2016

accepted 05 August 2016

Publication Date:
02 September 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Implantation of a duodenal-jejunal endoluminal bypass liner (DJBL) has shown to induce weight loss and to improve metabolic parameters. DJBL is a reversible endoduodenal sleeve mimicking duodenal bypass while lacking risks and limitations of bariatric surgery.

Effects on metabolic control, body mass parameters, appetite regulation, glucose tolerance, organ health, and lipid profile were determined in 16 morbidly overweight patients with type 2 diabetes mellitus. In addition, relevant hormones (leptin, ghrelin, gastric inhibitory peptide, glucagon-like peptide, and insulin) were measured by enzyme-linked immunosorbent assay (ELISA) and chemiluminescent microparticle immunoassay (CMIA) at 0, 1, 32, and 52 weeks post-implant following a mixed meal tolerance test. Lipoprotein subclasses were analysed by proton nuclear magnetic resonance (1H NMR) spectrometry. DJBL provoked weight loss, a decrease in fat mass, and an improvement in insulin resistance and hepatic function in most but not all of the patients, but in the long term did not increase gut hormone fasting levels pointing to a combined effect of more than gut parameters alone. Lipidome analysis was done in 10 patients, allowing classification to responders and non-responders by reduction of sLDL-p subfraction; and to further analyse the atherogenic profile. Responders showed an overall more pronounced effect regarding improvement of HbA1c, BMI, and HOMA index.

Implantation of a DJBL in obese type 2 diabetes patients does not per se lead to an improvement of the metabolic situation. Further analyses including larger cohorts have to be performed to identify responding patients, to better treat non-responders and to analyse the key effectors.

Key words

duodenal jejunal bypass liner - obesity - weight loss therapy - lipidome profiling - glucagon-like peptide-1

* These authors contributed equally to this work.


 

  • References

  • 1 Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu YA, Bahalim AN, Farzadfar F, Riley LM, Ezzati M. C GBMRF . National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377: 557-567
    CrossrefPubMedGoogle Scholar
  • 2 Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999; 282: 1523-1529
    CrossrefPubMedGoogle Scholar
  • 3 Wing RR, Reboussin D, Lewis CE. Grp LAR. Intensive Lifestyle Intervention in Type 2 Diabetes REPLY. N Engl J Med 2013; 369: 2358-2359
    PubMedGoogle Scholar
  • 4 Eckel RH. Clinical practice. Nonsurgical management of obesity in adults. N Engl J Med 2008; 358: 1941-1950
    CrossrefPubMedGoogle Scholar
  • 5 Buchwald H. Metabolic Surgery for the Metabolic Syndrome. Atheroscler Suppl 2009; 10: e226
    CrossrefPubMedGoogle Scholar
  • 6 Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis. Am J Med 2009; 122: U248-U281
    CrossrefPubMedGoogle Scholar
  • 7 Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G, Rubino F. Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes. N Engl J Med 2012; 366: 1577-1585
    CrossrefPubMedGoogle Scholar
  • 8 Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357: 753-761
    CrossrefPubMedGoogle Scholar
  • 9 Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004; 240: 416-423 discussion 423–414
    CrossrefPubMedGoogle Scholar
  • 10 Sowemimo OA, Yood SM, Courtney J, Moore J, Huang M, Ross R, McMillian U, Ojo P, Reinhold RB. Natural history of morbid obesity without surgical intervention. Surg Obes Relat Dis 2007; 3: 73-77 discussion 77
    CrossrefPubMedGoogle Scholar
  • 11 Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273: 219-234
    CrossrefPubMedGoogle Scholar
  • 12 Schauer PR, Bhatt DL, Kashyap SR. Bariatric surgery versus intensive medical therapy for diabetes. N Engl J Med 2014; 371: 682
    PubMedGoogle Scholar
  • 13 Papalazarou A, Yannakoulia M, Kavouras SA, Komesidou V, Dimitriadis G, Papakonstantinou A, Sidossis LS. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Obesity (Silver Spring) 2010; 18: 1348-1353
    CrossrefPubMedGoogle Scholar
  • 14 Schouten R, Rijs CS, Bouvy ND, Hameeteman W, Koek GH, Janssen IMC, Greve JWM. A Multicenter Randomized Efficacy Study of the EndoBarrier Gastrointestinal Liner for Presurgical Weight Loss Prior to Bariatric Surgery. Ann Surg 2010; 251: 236-243
    CrossrefPubMedGoogle Scholar
  • 15 de Moura EGH, Orso IRB, Martins BD, Lopes GS, de Oliveira SL, Galvao-Neto MD, Mancini MC, Santo MA, Sakai P, Ramos AC, Garrido AB, Halpern A, Cecconello I. 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: 941-947
    CrossrefPubMedGoogle Scholar
  • 16 de Moura EGH, Martins BC, Lopes GS, Orso IRB, de Oliveira SL, Neto MPG, Mancini MC, Santo MA, Sakai P, Ramos AC, Garrido AB, Halpern A, Cecconello I. One-Year Results of an Endoscopic, Duodenal-Jejunal Exclusion Device For Weight Loss and Control of Type 2 Diabetes. Obesity 2011; 19: S57-S57
    PubMedGoogle Scholar
  • 17 Escalona A, Pimentel F, Sharp A, Becerra P, Slako M, Turiel D, Munoz R, Bambs C, Guzman S, Ibanez L, Gersin K. Weight Loss and Metabolic Improvement in Morbidly Obese Subjects Implanted for 1 Year With an Endoscopic Duodenal-Jejunal Bypass Liner. Ann Surg 2012; 255: 1080-1085
    CrossrefPubMedGoogle Scholar
  • 18 de Jonge C, Rensen SS, Verdam FJ, Vincent RP, Bloom SR, Buurman WA, le Roux CW, Schaper NC, Bouvy ND, Greve JWM. Endoscopic Duodenal-Jejunal Bypass Liner Rapidly Improves Type 2 Diabetes. Obes Surg 2013; 23: 1354-1360
    CrossrefPubMedGoogle Scholar
  • 19 Rodriguez-Grunert L, Neto MPG, Alamo M, Ramos AC, Baez PB, Tarnoff M. First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve. Surg Obes Relat Dis 2008; 4: 55-59
    CrossrefPubMedGoogle Scholar
  • 20 Koehestanie P, de Jonge C, Berends FJ, Janssen IM, Bouvy ND, Greve JWM. The Effect of the Endoscopic Duodenal-Jejunal Bypass Liner on Obesity and Type 2 Diabetes Mellitus, a Multicenter Randomized Controlled Trial. Annals of Surgery 2014; 260: 984-992
    CrossrefPubMedGoogle Scholar
  • 21 Tarnoff M, Rodriguez L, Escalona A, Ramos A, Neto M, Alamo M, Reyes E, Pimentel F, Ibanez L. 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. Surgical Endoscopy and Other Interventional Techniques 2009; 23: 650-656
    CrossrefPubMedGoogle Scholar
  • 22 Gersin KS, Rothstein RI, Rosenthal RJ, Stefanidis D, Deal SE, Kuwada TS, Laycock W, Adrales G, Vassiliou M, Szomstein S, Heller S, Joyce AM, Heiss F, Neponmayshy D. Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc 2010; 71: 976-982
    CrossrefPubMedGoogle Scholar
  • 23 Jain D, Singhal S. Endoscopic Bypass Using Endobarrier Devices Efficacy in Treating Obesity and Metabolic Syndrome. J Clin Gastroenterol 2015; 49: 799-803
    CrossrefPubMedGoogle Scholar
  • 24 Habegger KM, Al-Massadi O, Heppner KM, Myronovych A, Holland J, Berger J, Yi CX, Gao Y, Lehti M, Ottaway N, Amburgy S, Raver C, Muller TD, Pfluger PT, Kohli R, Perez-Tilve D, Seeley RJ, Tschop MH. Duodenal nutrient exclusion improves metabolic syndrome and stimulates villus hyperplasia. Gut 2014; 63: 1238-1246
    CrossrefPubMedGoogle Scholar
  • 25 Aguirre V, Stylopoulos N, Grinbaum R, Kaplan LM. An Endoluminal Sleeve Induces Substantial Weight Loss and Normalizes Glucose Homeostasis in Rats with Diet-Induced Obesity. Obesity 2008; 16: 2585-2592
    CrossrefPubMedGoogle Scholar
  • 26 Scott WR, Batterham RL. Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: understanding weight loss and improvements in type 2 diabetes after bariatric surgery. Am J Physiol Regul Integr Comp Physiol 2011; 301: R15-R27
    CrossrefPubMedGoogle Scholar
  • 27 Rubino F, R’Bibo SL, del Genio F, Mazumdar M, McGraw TE. Metabolic surgery: the role of the gastrointestinal tract in diabetes mellitus. Nat Rev Endocrinol 2010; 6: 102-109
    CrossrefPubMedGoogle Scholar
  • 28 Pournaras DJ, Osborne A, Hawkins SC, Vincent RP, Mahon D, Ewings P, Ghatei MA, Bloom SR, Welbourn R, le Roux CW. Remission of type 2 diabetes after gastric bypass and banding: mechanisms and 2 year outcomes. Ann Surg 2010; 252: 966-971
    CrossrefPubMedGoogle Scholar
  • 29 Salehi M, Prigeon RL, D’Alessio DA. Gastric bypass surgery enhances glucagon-like peptide 1-stimulated postprandial insulin secretion in humans. Diabetes 2011; 60: 2308-2314
    CrossrefPubMedGoogle Scholar
  • 30 Bose M, Teixeira J, Olivan B, Bawa B, Arias S, Machineni S, Pi-Sunyer FX, Scherer PE, Laferrere B. Weight loss and incretin responsiveness improve glucose control independently after gastric bypass surgery. J Diabetes 2010; 2: 47-55
    CrossrefPubMedGoogle Scholar
  • 31 Laferrere B, Swerdlow N, Bawa B, Arias S, Bose M, Olivan B, Teixeira J, McGinty J, Rother KI. Rise of oxyntomodulin in response to oral glucose after gastric bypass surgery in patients with type 2 diabetes. J Clin Endocrinol Metab 2010; 95: 4072-4076
    CrossrefPubMedGoogle Scholar
  • 32 Kashyap SR, Daud S, Kelly KR, Gastaldelli A, Win H, Brethauer S, Kirwan JP, Schauer PR. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes (Lond) 2010; 34: 462-471
    CrossrefPubMedGoogle Scholar
  • 33 Vidal J, Nicolau J, Romero F, Casamitjana R, Momblan D, Conget I, Morinigo R, Lacy AM. Long-term effects of Roux-en-Y gastric bypass surgery on plasma glucagon-like peptide-1 and islet function in morbidly obese subjects. J Clin Endocrinol Metab 2009; 94: 884-891
    CrossrefPubMedGoogle Scholar
  • 34 Falken Y, Hellstrom PM, Holst JJ, Naslund E. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab 2011; 96: 2227-2235
    CrossrefPubMedGoogle Scholar
  • 35 Jimenez A, Casamitjana R, Viaplana-Masclans J, Lacy A, Vidal J. GLP-1 action and glucose tolerance in subjects with remission of type 2 diabetes after gastric bypass surgery. Diabetes Care 2013; 36: 2062-2069
    CrossrefPubMedGoogle Scholar
  • 36 Jimenez A, Casamitjana R, Flores L, Delgado S, Lacy A, Vidal J. GLP-1 and the long-term outcome of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery in morbidly obese subjects. Ann Surg 2013; 257: 894-899
    CrossrefPubMedGoogle Scholar
  • 37 Diffenderfer MR, Schaefer EJ. The composition and metabolism of large and small LDL. Curr Opin Lipidol 2014; 25: 221-226
    CrossrefPubMedGoogle Scholar
  • 38 Krayenbuehl PA, Wiesli P, Schmid C, Lehmann R, Spinas GA, Berneis K. Insulin sensitivity in type 2 diabetes is closely associated with LDL particle size. Swiss Med Wkly 2008; 138: 275-280
    PubMedGoogle Scholar
  • 39 Tan CE, Foster L, Caslake MJ, Bedford D, Watson TD, McConnell M, Packard CJ, Shepherd J. Relations between plasma lipids and postheparin plasma lipases and VLDL and LDL subfraction patterns in normolipemic men and women. Arterioscler Thromb Vasc Biol 1995; 15: 1839-1848
    CrossrefPubMedGoogle Scholar
  • 40 Krauss RM. Dietary and genetic probes of atherogenic dyslipidemia. Arterioscler Thromb Vasc Biol 2005; 25: 2265-2272
    CrossrefPubMedGoogle Scholar
  • 41 Brennan AM, Mantzoros CS. Drug Insight: the role of leptin in human physiology and pathophysiology - emerging clinical applications. Nature Clinical Practice Endocrinol Metab 2006; 2: 318-327
    PubMedGoogle Scholar