Weight loss and the EndoBarrier

In contrast to the technique of gastric ballooning, which involves uptake of food from the stomach, the EndoBarrier is evidently a bypass sleeve or liner that is placed at the so-called duodenal-jejunal junction in the intestine.

Like all these new devices that are inserted into the digestive tract at various sites, the EndoBarrier is intended to reduce food uptake and induce weightloss without the patient having to undergo invasive surgery.

The EndoBarrier concept is still relatively new and has as yet not been approved by the FDA in America or the NHS in the UK. Certain experts, such as Dr David Ashton of the UK (2011), are opposed to the use of the device because it appears to have a high rate of negative side-effects (abdominal pain, nausea, obstruction, etc), necessitating removal of the sleeve before the allotted time. In addition, it was found that many of the patients regained most of the weight they had lost once the EndoBarrier was removed and they reverted to their old eating habits.

EndoBarrier Study

Although most medical experts warn that the EndoBarrier has as yet not been tested thoroughly enough to warrant its extensive use, some studies are being conducted to shed more light on this technique, as well as its advantages and disadvantages. One such study to determine the safety and efficacy of the EndoBarrier was carried out in The Netherlands by Dr Schouten and his team (2010).

In this randomised trial, twenty-six out of thirty patients had the EndoBarrier successfully implanted, while 11 patients acted as the diet control group. All 37 participating subjects used the same low-kJ diet for 3 months. In must be noted, that in 4 of the prospective subjects, the device could not be implanted because of various problems experienced during the procedure such as migration of the device, sleeve obstruction and continuous epigastric pain.

According to the authors the procedure of placing the EndoBarrier took 35 minutes, while removal or explantation took 17 minutes, on average.

Results:

• All the patients (100%) fitted with an EndoBarrier had at least one negative side-effect such as nausea and abdominal pain, particularly during the first week after implantation
• In comparison to the 11 patients who used only the low-kJ diet, those patients who had successfully received an EndoBarrier lost 19% of their body weight versus 6.9% with diet alone, over the 3 month period.
• The patients fitted with an EndoBarrier reduced their BMIs by 5.5 compared to 1.9 kg/m2 in the diet-only group.
• Obesity comorbidities such as diabetes mellitus which was present in 8 of the treatment group, improved in 7 of the EndoBarrier patients who achieved weightloss over the 3 month period. Improvement was associated with lower glucose levels and reduced medication requirements.

Conclusions:

Dr Schouten and his team (2010) concluded that, “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.” The researchers suggest that large studies over longer periods need to be carried out to more precisely define the role of the EndoBarrier in the treatment of morbid obesity.

It is possible that some of the bariatric surgeons in South Africa will consider using the EndoBarrier, so each patient who goes for counselling before a bariatric procedure needs to discuss this potential weightloss method with the doctor and his/her team. The surgeon will have to decide it you are a candidate for bariatric surgery and what type of procedure is best suited to your situation, type of obesity and a variety of other factors.

The first step in getting bariatric assistance is, therefore, to talk to the surgeon who will be treating you. Ask the doctor if he or she uses the EndoBarrier and if this would be an option in your treatment.

(Dr IV van Heerden, aka DietDoc, April 2012)

References:

Ashton D (2011). News. Dr Ashton - Sept 2011- “No” to EndoBarrier. ; Gangemi S (2011). Easy on the carbs - Get lean, Get Fast. 29 March 2011. Health Seekers (2012). ELIM- Energy level Indicator Monitor. ;Schouten R et al (2010). A multicenter, randomised efficacy study of the EndoBarrier Gastrointestinal Liner for presurgical weight loss prior to bariatric surgery. Ann Surg, 251(2):236-43;