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 (1 H 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
