Introduction Bariatric surgery is the best available intervention for weight reduction in morbidly obese patients. Although outcomes are not quite comparable to surgery, an endoscopically implanted device called the Endobarrier (Endoscopic duodenojejunal bypass liner) can lead to significant weight loss and improvement of glycaemic control when compared to either dietary caloric restriction or sham procedures. Surgery may be complicated in high-risk groups like patients with poorly controlled diabetes, multiple co-morbidities or a body mass index (BMI) >50 kg/m2. We aimed to analyse the effect of an Endobarrier as an effective risk reducing tool in such high-risk patients prior to surgery.
Methods All patients who underwent an Endobarrier insertion between January and October, 2013 were analysed. This included patients with poorly controlled diabetes, patients with a BMI >50 kg/m2 or those who were at a high risk of peri-operative complications based on obesity surgery mortality risk score (OSMRS: normal score 1–5). Patient outcomes which included length of stay, complications, weight loss, and impact on glycaemic control were prospectively observed.
Results The Endobarrier was inserted in 18 patients (13 M) with median age of 53 years (range 32–68), median weight 159 kg (range 102–237), median BMI 54 kg/m2 (range 37–70.4) and a median OSMRS of 4 (mortality risk=2.4%). Device insertion was successful in all patients with no early removals required to date. The median length of stay was 1 day (range 1–5). There were no major complications apart from a single case of upper GI bleed 3 months later, which settled conservatively. Median weight over 3–6 months was now reduced to 147 kg (range 77–192) with median weight loss of 16.2 kg (6.9–41 kg) and 20.4 kg (9–47 kg) at 3 and 6 months respectively. Post-procedure, diabetic medication were either decreased (n = 9/11) or no longer required (n = 2/11) in diabetic patients and at 3 months HbA1C levels improved significantly from a median of 8.7 to 6.7% (p = 0.01).
Conclusion Endobarrier may be used as a stepping stone to surgery in high risk patients by safely and effectively reducing weight and improving glycaemic control.
Disclosure of Interest None Declared.
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