The duodenal-jejunal bypass sleeve (EndoBarrier Gastrointestinal Liner) for weight loss and treatment of type 2 diabetes

Background: Surgical intervention is now the most effective modality with which to treat severe obesity. There is currently a lack of minimally invasive technology with which we can effectively treat obesity and reverse type 2 diabetes mellitus. The EndoBarrier is a fluoropolymer sleeve that is reversibly fixated to the duodenal bulb and extends 80 cm into the small bowel, usually terminating in the proximal jejunum. This endoscopically inserted device aids weight loss through malabsorption and activating hormonal triggers. Methods: We conducted a nonsystematic review on worldwide articles published on the MEDLINE database to ascertain progress in the development and use of the EndoBarrier. Results: Most studies used 12-week excess weight loss (EWL) as a primary outcome measure with results ranging from 11.9%-23.6%. One study to date used 52-week EWL as its primary measure with a significant outcome of 47%. Our group has seen this technology cause significant weight loss, resolution of type 2 diabetes mellitus, and improvement in cardiovascular risk factor profile. Conclusions: The EndoBarrier shows promise in the surgical weight loss arena. This review article summarizes the technical aspects of this new technology, provides preliminary efficacy results, and introduces the roles it may play in the future of bariatric surgery. (c) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.