- 作者：Alex Escalona ; M.D.a ; Ricardo Yá ; ñ ; ez ; M.D.a ; Fernando Pimentel ; M.D.a ; Manoel Galvao ; M.D.b ; Almino Cardoso Ramos ; M.D.b ; Dannae Turiel ; M.D.a ; Camilo Boza ; M.D.a ; Diego Awruch ; M.D.a ; Keith Gersin ; M.D.c ; keith.gersin@carolinashealthcare.org ; Luis Ibá ; ñ ; ez ; M.D.a
- 关键词：Bariatric surgery ; Obesity treatment ; EndoBarrier gastrointestinal liner ; Gastric emptying
- 刊名：Surgery for Obesity and Related Diseases
- 出版年：2010
- 出版时间：4 March 2010
- 年：2010
- 卷：6
- 期：2
- 页码：126-131
- 全文大小：621 K
Background
The duodenal-jejunal bypass liner is an endoscopically placed and removable intestinal liner that creates a duodenal-jejunal bypass, leading to diabetes improvement and weight loss. The aim of the present study was to evaluate the clinical effects and safety of the duodenal-jejunal bypass liner combined with a restrictor orifice (flow restrictor).Methods
The device was endoscopically implanted in 10 patients (body mass index 40.8 ¡À 4.0 kg/m2) and removed after 12 weeks. Dilation of the restrictor orifice was performed as clinically indicated with a 6-, 8-, or 10-mm diameter through-the-scope balloon. The measured outcomes included the percentage of excess weight loss, total weight loss, adverse events, and gastric emptying (GE) at baseline, weeks 4 and 12 of implantation, and 3? months after device removal. GE was measured by scintigraphy at 1, 2, and 4 hours after implantation.
Results
The percentage of excess weight loss and total weight loss at explantation was 40 % ¡À 3 % (range 21?4 % ) and 16.7 ¡À 1.4 kg (range 12.0?6.0), respectively. The 4-hour GE was 98 % ¡À 1 % at baseline, 72 % ¡À 6 % at 4 weeks (P = 0.001 versus baseline), and 84 % ¡À 5 % at 12 weeks (P <.05 versus baseline). After explantation, the rate of GE returned to normal in 7 of 8 subjects, but remained slightly delayed in 1 subject (84 % at 4 hours). Episodes of nausea, vomiting, and abdominal pain required endoscopic dilation of the restrictor orifice with a 6-mm through-the-scope balloon in 7 patients and a 10-mm balloon in 1, with no clinically significant adverse events.
Conclusion
Endoscopic implantation of a combination flow restrictor and duodenal-jejunal bypass liner induced substantial weight loss. The implanted patients exhibited delayed GE that was reversed after device removal.