十二指肠空肠搭桥术衬垫治疗T2DM和肥胖:首个国家医疗服务体系(NHS)EndoBarrier服务的4年结果

IF 0.4 Q4 ENDOCRINOLOGY & METABOLISM British Journal of Diabetes Pub Date : 2022-11-18 DOI:10.15277/bjd.2022.351
R. Ryder, Mahender Yadagiri, W. Burbridge, S. Irwin, H. Gandhi, T. Bashir, Rachael A Allden, Melanie C. Wyres, M. Cull, Jo Bleasdale, E. Fogden, Mark R. Anderson, P. Sen Gupta
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引用次数: 1

摘要

背景和目的:EndoBarrier是一种60厘米的十二指肠空肠旁路内衬,经内镜植入长达一年,旨在模仿roux-en-Y减肥手术的旁路部分。移除内衬后,与EndoBarrier治疗相关的改善程度存在不确定性。因此,我们旨在为难治性糖尿病建立EndoBarrier服务,并在移除EndoBarriers后继续监测糖尿病患者。方法:2014年10月至2017年11月,我们在NHS服务中植入了62个EndoBarriers。截至2018年11月,所有项目均已拆除。在登记处监测结果。结果:截至2021年11月,所有患者在移除EndoBarrier后均达到三年,其中43/62(69%)(平均±SD年龄51.6±7.6岁,55.8%男性,55.8%白人,中位[IQR]糖尿病持续时间14.6[8-21]年,62.8%胰岛素治疗,平均±SD BMI 41.7±7.3 kg/m2)接受了随访。在参与EndoBarrier植入的患者中,平均±SD HbA1c从76.3±19.2下降20.6±19.6 mmol/mol至55.7±11.1 mmol/mol(p<0.001)(从9.1±1.8%下降1.9±1.8%至7.2±1.0%【p<0.001】),体重从123.3±30.0 kg下降17.4±9.1 kg至105.9±30.8 kg(p<001),BMI从41.7±7.3下降至35.6±7.7 kg/m2(p<0.01),收缩压从138.7±14.4降至125.4±14.7 mmHg(p<0.001),胆固醇从4.6±1.0降至3.7±0.7mmol/L(p<0.01),血清丙氨酸氨基转移酶从30.8±17.2降至19.3±11.2 U/L(p<001)。在服用胰岛素中位数(IQR)的患者中,每日胰岛素总剂量从114(54–180)单位降至20(0–65)单位(n=27,p<0.001;10/27(37%)接受胰岛素治疗的人能够停用胰岛素。EndoBarrier去除三年后,33/43(77%)保持了EndoBarriere的大部分改善,而10/43(23%)恢复到基线。在病情恶化的患者中,9/10(90%)患有抑郁症和/或丧亲之痛和/或重大健康问题/残疾。10/62(16%)因不良事件或症状需要早期移除Endo屏障;所有10例患者在切除后均完全康复,并获得了最显著的益处。结论:我们的数据表明,EndoBarrier对难治性糖尿病患者非常有效,77%的病例在切除后三年仍有显著改善。
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Duodenal-jejunal bypass liner for treatment of T2DM and obesity: 4-year outcomes in the first National Health Service (NHS) EndoBarrier service
Background and aims: EndoBarrier is a 60cm duodenal-jejunal bypass liner endoscopically implanted for up to one year and designed to mimic the bypass part of roux-en-Y bariatric surgery. There is uncertainty concerning the extent to which improvements associated with EndoBarrier treatment are sus-tained once the liner has been removed. We aimed therefore to establish an EndoBarrier service for refractory diabesity and to continue to monitor the people with diabetes after EndoBarrier removal. Methods: Between October 2014 and November 2017, we implanted 62 EndoBarriers in our NHS service. All had been removed by November 2018. Outcomes were monitored in a registry. Results: As of November 2021, all patients reached three years after EndoBarrier removal and of these 43/62 (69%) (mean±SD age 51.6 ± 7.6 years, 55.8% male, 55.8% white ethnicity, median [IQR] diabetes duration 14.6 [8 – 21] years, 62.8% insulin-treated, mean±SD BMI 41.7±7.3 kg/m2) attended follow-up. In those who attended, during EndoBarrier implantation mean±SD HbA1c fell by 20.6±19.6 mmol/mol from 76.3±19.2 to 55.7±11.1 mmol/mol (p<0.001) (by 1.9±1.8% from 9.1±1.8% to 7.2±1.0% [p<0.001]), weight fell by 17.4±9.1 kg from 123.3±30.0 kg to 105.9±30.8 kg (p<0.001), BMI fell from 41.7±7.3 to 35.6±7.7 kg/m2 (p<0.001), systolic blood pressure from 138.7±14.4 to 125.4±14.7 mmHg (p<0.001), cholesterol from 4.6±1.0 to 3.7±0.7mmol/L (p<0.001), and serum alanine aminotransferase from 30.8±17.2 to 19.3±11.2 U/L (p<0.001). In those taking insulin median (IQR) total daily insulin dose reduced from 114 (54–180) to 20 (0–65) units (n=27, p<0.001); 10/27 (37%) insulin-treated people were able to discontinue insulin. Three years after EndoBarrier removal 33/43 (77%) maintained most of the improvement achieved with EndoBarrier whilst 10/43(23%) reverted to baseline. Of those deteriorating 9/10(90%) had depression and/or bereavement and/or major health problems/disability. 10/62(16%) required early Endo-Barrier removal for adverse events or symptoms; all 10 fully recovered after removal and most derived significant benefit. Conclusions: Our data demonstrate that EndoBarrier is highly effective in people with refractory diabesity, with mainte-nance of significant improvement three years after removal in 77% of cases.
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British Journal of Diabetes
British Journal of Diabetes ENDOCRINOLOGY & METABOLISM-
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16.70%
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