Endoscopic bariatric procedures including Duedenal Jejunal Bypass Liner (DJBL) have become widespread in obesity treatment in recent years. The aim of this systematic review was to assess the role of DJBL in obesity treatment. A comprehensive search of several databases, including Cochrane Library, PubMed, and Web of Science was conducted to December 2020. Twenty-four clinical studies were assessed. According to the results, it is clear that DJBL provides effective weight reduction at 6–12 months and significant improvements in parameters associated with metabolic syndrome and cardiovascular disease. This technique also has potential to reduce comedications in patients with obesity and type 2 diabetes. Although these positive effects of DJBL are clear, its effect on liver, pancreatic functions, and inflammation markers are not clear yet. In addition, the overall and serious complication (gastrointestinal bleeds, pancreatitis, hepatic abscess, obstruction of the sleeve, biliary colic without cholecystitis and cholangitis) rate causing from the DJBL is very high. DJBL has not been approved by the Food and Drug Administration due to the frequency and severity of complications it causes. While it is certain that DJBL has significant effects on obesity and obesity related comorbidities, the safety aspect needs to be improved.
Citation: Taha Gökmen Ülger, Muhittin Tayfur, Funda Pınar Çakıroğlu, Çiğdem Özcan. The role of duodenal jejunal bypass liner in obesity treatment[J]. AIMS Medical Science, 2021, 8(3): 224-236. doi: 10.3934/medsci.2021019
Endoscopic bariatric procedures including Duedenal Jejunal Bypass Liner (DJBL) have become widespread in obesity treatment in recent years. The aim of this systematic review was to assess the role of DJBL in obesity treatment. A comprehensive search of several databases, including Cochrane Library, PubMed, and Web of Science was conducted to December 2020. Twenty-four clinical studies were assessed. According to the results, it is clear that DJBL provides effective weight reduction at 6–12 months and significant improvements in parameters associated with metabolic syndrome and cardiovascular disease. This technique also has potential to reduce comedications in patients with obesity and type 2 diabetes. Although these positive effects of DJBL are clear, its effect on liver, pancreatic functions, and inflammation markers are not clear yet. In addition, the overall and serious complication (gastrointestinal bleeds, pancreatitis, hepatic abscess, obstruction of the sleeve, biliary colic without cholecystitis and cholangitis) rate causing from the DJBL is very high. DJBL has not been approved by the Food and Drug Administration due to the frequency and severity of complications it causes. While it is certain that DJBL has significant effects on obesity and obesity related comorbidities, the safety aspect needs to be improved.
| [1] |
Blüher M (2019) Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol 15: 288-298. 
|
| [2] |
Kaválková P, Mráz M, Trachta P, et al. (2016) Endocrine effects of duodenal–jejunal exclusion in obese patients with type 2 diabetes mellitus. J Endocrinol 231: 11-22.
|
| [3] |
Quezada N, Muñoz R, Morelli C, et al. (2018) Safety and efficacy of the endoscopic duodenal–jejunal bypass liner prototype in severe or morbidly obese subjects implanted for up to 3 years. Surg Endosc 32: 260-267.
|
| [4] |
De Moura EGH, Orso IRB, Martins BDC, et al. (2011) Improvement of insulin resistance and reduction of cardiovascular risk among obese patients with type 2 diabetes with the duodenojejunal bypass liner. Obes Surg 21: 941-947.
|
| [5] |
Muñoz R, Dominguez A, Muñoz F, et al. (2014) Baseline glycated hemoglobin levels are associated with duodenal-jejunal bypass liner-induced weight loss in obese patients. Surg Endosc 28: 1056-1062.
|
| [6] |
Koehestanie P, De Jonge C, Berends FJ, et al. (2014) The effect of the endoscopic duodenal-jejunal bypass liner on obesity and type 2 diabetes mellitus, a multicenter randomized controlled trial. Ann Surg 260: 984-992.
|
| [7] |
Vilarrasa N, De Gordejuela AGR, Casajoana A, et al. (2017) Endobarrier® in grade I obese patients with long-standing type 2 diabetes: role of gastrointestinal hormones in glucose metabolism. Obes Surg 27: 569-577.
|
| [8] |
Deutsch L, Haim LB, Sofer Y, et al. (2018) Long-term effects of proximal small bowel exclusion by duodenal-jejunal bypass liner on weight reduction and glycemic control in diabetic patients. Surg Obes Relat Dis 14: 1561-1569.
|
| [9] |
Caiazzo R, Branche J, Raverdy V, et al. (2020) Efficacy and Safety of the Duodeno-Jejunal Bypass Liner in patients with metabolic syndrome: a multicenter randomized controlled trial (ENDOMETAB). Ann Surg 272: 696-702.
|
| [10] |
Ryder REJ, Irwin SP, Burbridge W, et al. (2019) The United Kingdom's first NHS Endobarrier service for advanced diabesity: 1-year outcomes for all 62 treated patients. Br J Diabetes 19: 110-117.
|
| [11] |
Ruban A, Glaysher MA, Miras AD, et al. (2020) A duodenal sleeve bypass device added to intensive medical therapy for obesity with type 2 diabetes: a RCT. Efficacy Mechanism Evaluation 7: 1-164.
|
| [12] |
Glaysher MA, Ward J, Aldhwayan M, et al. (2020) The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids. Clin Nutr 40: 2343-2354.
|
| [13] |
Escalona A, Pimentel F, Sharp A, et al. (2012) Weight loss and metabolic improvement in morbidly obese subjects implanted for 1 year with an endoscopic duodenal-jejunal bypass liner. Ann Surg 255: 1080-1085.
|
| [14] |
Van Rijn S, Betzel B, De Jonge C, et al. (2018) The effect of 6 and 12 months duodenal-jejunal bypass liner treatment on obesity and type 2 diabetes: a crossover cohort study. Obes Surg 28: 1255-1262.
|
| [15] |
Patel N, Mohanaruban A, Ashrafian H, et al. (2018) EndoBarrier®: a safe and effective novel treatment for obesity and type 2 diabetes?. Obes Surg 28: 1980-1989.
|
| [16] |
Colás A, Varela M, Mraz M, et al. (2020) Influence of glucometric “dynamical” variables on duodenal-jejunal bypass liner (DJBL) anthropometric and metabolic outcomes. Diabetes Metab Res Rev 36: e3287.
|
| [17] |
Riedel N, Laubner K, Lautenbach A, et al. (2018) Longitudinal evaluation of efficacy, safety and nutritional status during one-year treatment with the duodenal-jejunal bypass liner. Surg Obes Relat Dis 14: 769-779.
|
| [18] |
Roehlen N, Laubner K, Bettinger D, et al. (2020) Duodenal-jejunal bypass liner (djbl) ımproves cardiovascular risk biomarkers and predicted 4-year risk of major cv events in patients with type 2 diabetes and metabolic syndrome. Obes Surg 30: 1200-1210.
|
| [19] |
Schouten R, Rijs CS, Bouvy ND, et al. (2010) A multicenter, randomized efficacy study of the EndoBarrier Gastrointestinal Liner for presurgical weight loss prior to bariatric surgery. Ann Surg 251: 236-243.
|
| [20] |
Betzel B, Koehestanie P, Homan J, et al. (2017a) Changes in glycemic control and body weight after explantation of the duodenal-jejunal bypass liner. Gastrointest Endosc 85: 409-415.
|
| [21] |
Betzel B, Homan J, Aarts EO, et al. (2017b) Weight reduction and improvement in diabetes by the duodenal-jejunal bypass liner: a 198 patient cohort study. Surg Endosc 31: 2881-2891.
|
| [22] |
Gersin KS, Rothstein RI, Rosenthal RJ, et al. (2010) Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc 71: 976-982.
|
| [23] |
Tarnoff M, Rodriguez L, Escalona A, et al. (2009) 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. Surg Endosc 23: 650-656.
|
| [24] |
Betzel B, Cooiman MI, Aarts EO, et al. (2020) Clinical follow-up on weight loss, glycemic control, and safety aspects of 24 months of duodenal-jejunal bypass liner implantation. Surg Endosc 34: 209-215.
|
| [25] |
De Moura EGH, Lopes GS, Martins BC, et al. (2015) Effects of duodenal-jejunal bypass liner (EndoBarrier®) on gastric emptying in obese and type 2 diabetic patients. Obes Surg 25: 1618-1625.
|
| [26] |
Betzel B, Drenth JP, Siersema PD (2018) Adverse events of the duodenal-jejunal bypass liner: a systematic review. Obes Surg 28: 3669-3677.
|
| [27] |
Betzel B, Homan J, Aarts E, et al. (2015) Acute pancreatitis as an adverse event in patients with the duodenal-jejunal bypass liner. Endoscopy 47: 1050-1053.
|
| [28] |
De Jonge C, Rensen SS, D'Agnolo HM, et al. (2014) Six months of treatment with the endoscopic duodenal-jejunal bypass liner does not lead to decreased systemic inflammation in obese patients with type 2 diabetes. Obes Surg 24: 337-341.
|
| [29] |
Ruban A, Glaysher M, Miras A, et al. (2020) One year of duodenal-jejunal bypass liner therapy (endobarrier®) leads to significant changes in liver biochemistry associated with non-alcoholic fatty liver disease. Gastrointest Endosc 91: AB225-AB226.
|
| [30] |
Van Nierop FS, De Jonge C, Kulik W, et al. (2019) Duodenal-jejunal lining increases postprandial unconjugated bile acid responses and disrupts the bile acid-FXR-FGF19 axis in humans. Metabolism 93: 25-32.
|
| [31] |
Koehestanie P, Dogan K, Berends F, et al. (2014) Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels. Endosc Int Open 2: E21-E27.
|
| [32] |
De Jonge C, Fuentes S, Zoetendal EG, et al. (2019) Metabolic improvement in obese patients after duodenal–jejunal exclusion is associated with intestinal microbiota composition changes. Int J Obes 43: 2509-2517.
|
| [33] |
Escalona A, Yáñez R, Pimentel F, et al. (2010) Initial human experience with restrictive duodenal-jejunal bypass liner for treatment of morbid obesity. Surg Obes Relat Dis 6: 126-131.
|
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Taha Gökmen Ülger, Muhittin Tayfur, Funda Pınar Çakıroğlu, Çiğdem Özcan. The role of duodenal jejunal bypass liner in obesity treatment[J]. AIMS Medical Science, 2021, 8(3): 224-236. doi: 10.3934/medsci.2021019
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