The Best of ASGE Endoscopy from DDW | June 2021-Kalapala_ABE_AnnualCourse2021

Kalapala_ABE_AnnualCourse2021_Diabetes-Epidemic

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AIG Hospitals in Hyderabad, India is focused on addressing the diabetes epidemic through small bowel-based metabolic devices. These devices, which are distinct from restrictive therapies, work to modify the metabolic pathway by channeling food through the small intestine without contacting the intestinal wall. This leads to increased metabolic rate, reduced insulin resistance, earlier satiety, and weight loss. According to clinical results, patients experienced reductions in fasting blood glucose, fasting insulin, and HbA1c levels.<br /><br />One device, called the EndoBarrier System, was initially promising but had to stop its FDA trial due to safety concerns such as perforation of the barbs in the duodenum. However, there is a next-generation solution called the EndoSleeve™ which has regulatory approvals in international markets and has shown positive efficacy results.<br /><br />Anchoring methodologies of duodenal-jejunal bypass liners include barbs penetrating the duodenal bulb or a net shape across the pylorus. Distal migration mechanisms can occur due to the variability in the size of the aperture and distensibility of the pylorus. To resolve this, a suture tether delivery procedure can be used to secure the implant in place.<br /><br />Another procedure worth mentioning is the endoscopic dual-path enteral anastomosis using self-assembling magnets. Coupled magnets form a large caliber, permanent bypass of the gastrointestinal tract and are naturally expelled with no adhesions or implants.<br /><br />Revita, a procedure by Fractyl Laboratories, focuses on duodenal mucosal resurfacing. Clinical data shows glycemic improvement up to 12 months, as well as reductions in microalbuminuria and alanine transaminase (ALT).<br /><br />Overall, these small bowel-based metabolic devices offer potential solutions for addressing diabetes and obesity by modifying the metabolic pathway and providing sustained weight loss and metabolic improvements.

Keywords

AIG Hospitals

diabetes epidemic

metabolic devices

EndoBarrier System

EndoSleeve

duodenal-jejunal bypass liners

suture tether delivery procedure

endoscopic dual-path enteral anastomosis

Revita

duodenal mucosal resurfacing