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A Multicenter, Randomized Efficacy Study of the EndoBarrier Gastrointestinal Liner for Presurgical Weight Loss Prior to Bariatric Surgery

Schouten, Ruben MD*; Rijs, Carianne S. MD; Bouvy, Nicole D. MD, PhD; Hameeteman, Wim MD, PhD§; Koek, Ger H. MD, PhD§; Janssen, Ignace M. C. MD; Greve, Jan-Willem M. MD, PhD*

doi: 10.1097/SLA.0b013e3181bdfbff
Randomized Controlled Trial

Background: The endoscopically placed duodenal-jejunal bypass sleeve or EndoBarrier Gastrointestinal Liner has been designed to achieve weight loss in morbidly obese patients. We report on the first European experience with this device.

Methods: A multicenter, randomized clinical trial was performed. Forty-one patients were included and 30 underwent sleeve implantation. Eleven patients served as a diet control group. All patients followed the same low-calorie diet during the study period. The purpose of the study was to determine the safety and efficacy of the device.

Results: Twenty-six devices were successfully implanted. In 4 patients, implantation could not be achieved. Four devices were explanted prior to the initial protocol end point because of migration (1), dislocation of the anchor (1), sleeve obstruction (1), and continuous epigastric pain (1). The remaining patients all completed the study. Mean procedure time was 35 minutes (range: 12–102 minutes) for a successful implantation and 17 minutes (range: 5–99 minutes) for explantation. There were no procedure related adverse events. During the study period the 26 duodenal-jejunal bypass sleeve patients (100%) had at least one adverse event, mainly abdominal pain and nausea during the first week after implantation. Initial mean body mass index (BMI, kg/m2) was 48.9 and 47.4 kg/m2 for the device and control patients, respectively. Mean excess weight loss after 3 months was 19.0% for device patients versus 6.9% for control patients (P < 0.002). Absolute change in BMI at 3 months was 5.5 and 1.9 kg/m2, respectively. Type 2 diabetes mellitus was present at baseline in 8 patients of the device group and improved in 7 patients during the study period (lower glucose levels, HbA1c, and medication requirements).

Conclusion: The EndoBarrier Gastrointestinal Liner is a feasible and safe noninvasive device with excellent short-term weight loss results. The device also has a significant positive effect on type 2 diabetes mellitus. Long-term randomized and sham studies for weight loss and treatment of diabetes are necessary to determine the role of the device in the treatment of morbid obesity.

This study was registered at www.clinicaltrials.gov (registration number: NCT00830440).

This randomized trial comparing the endoscopically placed duodenal-jejunal bypass sleeve with a diet control group showed significantly better weight loss in the device group. The positive effect of the device on type 2 diabetes needs further investigation.

From the *Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; †Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; ‡Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; and §Department of Internal Medicine, Division of Gasteroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.

Supported by GI Dynamics, Inc (Lexington, MA).

None of the authors have any commercial involvement with the EndoBarrier Gastrointestinal Liner or any financial connection with the producing company (GI Dynamics, Inc, Lexington, MA).

All data were collected under the supervision of MedPass (MedPass International, Paris, France).

Reprints: Ruben Schouten, MD, Department of Surgery, Atrium Medical Centre, PO box 4446, 6401 CX Heerlen, The Netherlands. E-mail: schoutenruben@hotmail.com.

© 2010 Lippincott Williams & Wilkins, Inc.