The Duodenal-Endoluminal Sleeve Barrier: A Less Invasive Procedure To Reverse Obesity

Matengo Chwanya's picture

I have never undergone major surgery, but from the few minor operations I have suffered through, I am certain it is an experience I would rather pass.

But in many obesity related cases, surgery is often the alternative with the best outcomes. However, like all other surgeries, it comes with numerous complications. The term "complication" here is used liberally, as this can be something as different as having to watch the amount you consume to taking care not to get pregnant post-operation.

A combined team of scientists from the Metabolic Disease Institute, University of Cincinnati, and the Helmholtz Diabetic Center, Germany,  have confirmed the success of a removable intestinal barrier. This findings should give many hope as this less invasive and easily reversible procedure could be the way to effective weight loss in obese individuals.

What Are the Current Bariatric Surgical Procedures?

There are currently four procedures that you can opt for, and these are:

Adjustable Gastric Banding (AGB)

A loop is placed around the upper part of the stomach, creating a very small pouch. This loop is adjustable so that the passage of food is variable. It is a simple procedure with relatively fewer complications.

Roux-en-Y gastric bypass (RYGB)

The stomach is reduced to a small pouch delimited by surgical staples, and then pouch is directly connected to the small intestines. The pouch is about the size of an egg, and this procedure brings about malabsorption, forcing the person to live on multivitamins for life.

Vertical sleeve gastrectomy (VSG)

In this procedure, a portion (80%) of the stomach is excised, thus physically reducing the size of the stomach, sometimes to the size of a banana. These procedure is not reversible.

How Does This New Barrier Differ?

The end game for all procedures used to fight obesity is to reduce the nutrients absorbed, and thus drastically cut down your caloric intake. AGB forcefully limits the amount you can eat, and thus the amount of nutrients you can absorb. RYGB reduces the amount of food you can consume, but also bypasses the duodenum, where most food is broken down; consequently, you cannot absorb as much as before. VSG works like AGB.

How else can you reduce nutrient uptake? It’s simple really, get a barrier to line the small intestines. This barrier is the duodenal-endoluminal sleeve (DES). The beauty of it is that the procedure is fairly simple, not much different to gastroscopy. The DES is a flexible tube which when placed in the small intestines can, in theory, prevent the interaction between food substances and intestinal tissue, and can thus prevent the breakdown of food or the absorption of nutrients.

The Experiment That Confirmed This

The researchers used Zucker Diabetic Fatty (ZDF) rats, which are used as animal models in understanding obesity, diabetes and related diseases. These rats were then split into four random groups: DES implanted, naïve, sham pair-fed, and sham ad libitum.

The parameters that were measured during the experiment were food intake, body composition and body weight. So too were the levels of lipid, bile acid and glucose metabolism in the 28-day experiment. A histological assay was also carried out.  

Their Findings

The body weights of the DES-implanted rats reduced throughout the experiment, and this was a loss in body fat, not muscle. Furthermore, their glucose tolerance had also improved dramatically, while levels of circulating fats had dropped as bile levels rose.

Intriguingly, the villi, the finger-like projections that line the intestines and act as absorbing surfaces for nutrients, had grown in length in these rats.

Where To Go From Here

The benefits of this procedure are clear, and is in all likelihood a safer alternative to conventional procedures. While these guys are still thinking of modeling human trials, I would like to bring your attention to a recent creation by an Israeli university.

Students at the Hebrew University of Jerusalem and Hadassah Medical Center have already developed the “MetaboShield”, a C-shaped tube that is for all intents and purposes, the duodenal-endoluminal sleeve. Or it is the other way round; I can’t know who thought what before the other, but neither is certainly the first.

That is because US Patent (Use of an Adhesive as an Intestinal Barrier for Bariatrics) # 7,892, 220 B2, owned by Craig Fall et al, was first submitted in 2006, though it was only certified in 2011.

Whoever the owner is, what is certain is that the duodenal sleeve promises to be an effective method of checking obesity, especially when used in tandem with hormone therapy, specifically Glucagon Like Peptide (GLP-1), which has been found to enhance weight loss gains made in bariatric surgery.

Sources

http://gut.bmj.com/content/early/2013/10/08/gutjnl-2013-304583.abstract

http://www.helmholtz-muenchen.de/en/news/latest-news/press-releases-2013/press-release/article/21732/index.html

http://win.niddk.nih.gov/publications/gastric.htm

http://www.google.com/patents?hl=en&lr=&vid=USPAT7892220&id=PfMoAQAAEBAJ&oi=fnd&dq=intestinal+barrier+sleeves&printsec=abstract#v=onepage&q=intestinal%20barrier%20sleeves&f=false

http://www.ncbi.nlm.nih.gov/pubmed/23775764

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