- Title
- Induction of meal-related symptoms as a novel mechanism of action of the duodenal-Jejunal Bbpass sleeve
- Creator
- McMaster, Jessica J.; Rich, Graeme G.; Shanahan, Erin R.; Do, Anh T.; Fletcher, Linda M.; Kutyla, Marguerite J.; Tallis, Caroline; Jones, Mike P.; Talley, Nicholas J.; Macdonald, Graeme A.; Chachay, Veronique S.; Holtmann, Gerald J.
- Relation
- Journal of Clinical Gastroenterology Vol. 54, Issue 6, p. 528-535
- Publisher Link
- http://dx.doi.org/10.1097/MCG.0000000000001353
- Publisher
- Lippincott Williams & Wilkins
- Resource Type
- journal article
- Date
- 2020
- Description
- Background: Treatment with a duodenal-jejunal bypass sleeve (DJBS) induces clinically significant weight loss, but little is known about the mechanisms of action of this device. Aim: The aim of this study was to characterize the mechanisms of action of the DJBS and determine the durability of weight loss and metabolic improvements. Materials and Methods: We studied a cohort of 19 subjects with severe obesity and type 2 diabetes (baseline body mass index: 43.7 ± 5.3 kg/m2). Anthropometry, body composition, blood pres-sure, biochemical measures, and dietary intake were monitored for 48 weeks after DJBS implantation, and then for 1 year after device removal. Gastric emptying and triglyceride absorption were measured at baseline, 8 weeks after implant, and within 3 weeks of device explant. Visceral sensory function was assessed at baseline, 4 weeks after implant, and within 3 weeks after explant. Results: Significant weight loss (P<0.01) occurred following DJBS placement, with a mean weight reduction of 17.0 ± 6.5% at 48 weeks. The symptom burden following a standardized nutrient challenge was increased after DJBS implantation (P<0.05), returning to baseline after DJBS removal. Neither gastric emptying nor triglyceride absorption changed with the device in situ. A significant reduction in energy intake was observed [baseline: 7703 ± 2978 kJ (1841 ± 712 kcal), 24 weeks: 4824 ± 2259 kJ (1153 ± 540 kcal), and 48 weeks: 4474 ± 1468 kJ (1069 ± 351 kcal)]. After 1 year, anthropometry remained significantly improved, but there was no durable impact on metabolic outcomes. Conclusions: DJBS treatment resulted in substantial weight loss. Weight loss is related to reduced caloric intake, which seems linked to an augmented upper gastrointestinal symptom response, but not altered fat absorption.
- Subject
- obesity treatment; bariatric endoscopy; type 2 diabeties mellitus; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1436548
- Identifier
- uon:40059
- Identifier
- ISSN:0192-0790
- Language
- eng
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