Is re-implantation of the duodenal-jejunal bypass liner feasible?

Aim:

The endoscopically implanted DJBL is a 60-cm impermeable fluoropolymer device which prevents food from making contact with the proximal intestine, thus inducing considerable weight loss and improving type 2 diabetes mellitus (T2DM). Weight and HbA1c levels have been reported to increase post-explant. This study aimed to investigate the safety, feasibility and effectiveness of DJBL re-implantation in patients whose glucose levels relapse after explantation, and to assess how reimplantation affects BMI and T2DM control. This prospective, observational study was conducted at DGD Clinics Sachsenhausen (Dept. of Gastroenterology), Frankfurt, Germany, from 2014 – 2016.

Methods:

Five obese patients with T2DM and a BMI ranging from 35 – 59 kg/m², who completed follow-up after their first implant and underwent removal of DJBL after 12 months, were selected for re-implantation after an additional 4 months of follow-up. Weight loss, BMI and HbA1c were analyzed before and twelve months after reimplantation.

Results:

In all 5 patients, DJBL was implanted and explanted, and also re-implanted and re-explanted, without complications. Mean (± SD; range) body weight decreased significantly from 115.8 (45.4; 88 – 196)kg to 95.0 (38.8; 72 – 164)kg, and mean BMI (± SD; range) decreased from 40.9 (10.3; 35.3 – 59.2) to 33.5 (9.0; 29.549.5). The glycated haemoglobin (HbA1c) level decreased from 9.1% (1.3; 8 – 10.7) to 6.7% (0.9; 5.9 – 7.8) by the first implantation. After re-implantation, despite reduced medication, HbA1c levels remained stable.

Conclusions:

Results of this observational study show that DJBL re-implantation is feasible and safe only 4 months post-explantation. After re-implantation, weight and HbA1c levels decreased once again.