Duodenal jejunal bypass liner (DJBL) treatment for type 2 diabetes and obesity: a new evidence-based approach

Background: Duodenal jejunal bypass liner (DJBL), also known as EndoBarrier or RESET (Morphic Medical, Boston, USA), is a 60 cm long impermeable fluoropolymer sleeve which is implanted by endoscopy into the first part of the small intestine where it remains for about 1 year. It is held in place by a nitinol anchor, such that food passes through it without coming into contact with the small intestine and promoting improved glycaemic control and weight loss in patients with type 2 diabetes and obesity. However, many serious adverse events (SAEs) occur during the final three months of treatment, suggesting that a shorter, 9-month implantation may reduce complications.

Materials and methods: To assess risk-benefit profile of DJBL, an international online registry was established in 2017 under the auspices of the Association of British Clinical Diabetologists (ABCD). DJBL safety and efficacy data were entered into the registry from patients worldwide, enabling comparisons of outcomes between 9- and 12-month implantation durations, focusing on HbA1c, weight changes and SAEs.

Results: As of November 2024, data from 1,101 patients across 36 centres in 11 countries had been submitted. Of these, 238 had complete data at both 9 and 12 months. The patients were obese (BMI 39.6±7.0 kg/m²), aged 49.2±13.4 years, with 47.5% being male. DJBL led to significant reductions in HbA1c and weight. At 9 months, mean HbA1c dropped by 16.0±19.0 mmol/mol, similar to the 16.6±19.5 mmol/mol reduction at 12 months (p=0.262). Weight loss was 12.3±8.3 kg at 9 months vs. 13.3±8.8 kg at 12 months (p=0.006). Greater HbA1c reductions were seen in those with higher baseline levels, with minimal difference between durations. Among all patients, 47 (4.3%) experienced SAEs. Importantly, 15 of these (31.9%)—including 9 liver abscesses, 5 gastrointestinal bleeds, and 1 case of cholecystitis—occurred between months 9 and 12 and could have been avoided with earlier removal. Of the 14 total liver abscesses, 9 (64.3%) might have been prevented with a 9-month limit. All patients with SAEs made a full recovery.

Conclusion: Data from the international DJBL registry confirm its effectiveness in improving glycaemic control and promoting weight loss. Most therapeutic benefits are achieved by 9 months, with minimal additional gains at 12 months. Shortening the treatment period to 9 months could significantly reduce the risk of SAEs, particularly liver abscesses, without compromising efficacy.

Präsentiert in der Sitzung: Endoskope gegen Adipositas und Diabetes mellitus Typ II

Samstag, 20. September 2025, 10:15 – 11:45, MZF 3

Publication History

Article published online:
04 September 2025