Journal Article

Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study

Mertens, Ann, Rodriguez Grunert, Leonardo, Bisschops, Raf, van Baar, Annieke C G, Galvao Neto, Manoel, Magee, Cormac, Costamagna, Guido, Holleman, Frits, Crenier, Laurent, Vignolo, Paulina, Tijssen, Jan, Hopkins, David, Nieuwdorp, Max, Hayee, Bu’Hussain, Devière, Jacques, Haidry, Rehan, Guidone, Caterina, Bergman, Jacques J G H M

2020

Overview

BackgroundThe duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes. Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure that has been shown to improve glycaemic control in people with type 2 diabetes mellitus (T2D) irrespective of body mass index (BMI) changes. DMR involves catheter-based circumferential mucosal lifting followed by hydrothermal ablation of duodenal mucosa. This multicentre study evaluates safety and feasibility of DMR and its effect on glycaemia at 24 weeks and 12 months.MethodsInternational multicentre, open-label study. Patients (BMI 24–40) with T2D (HbA1c 59–86 mmol/mol (7.5%–10.0%)) on stable oral glucose-lowering medication underwent DMR. Glucose-lowering medication was kept stable for at least 24 weeks post DMR. During follow-up, HbA1c, fasting plasma glucose (FPG), weight, hepatic transaminases, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), adverse events (AEs) and treatment satisfaction were determined and analysed using repeated measures analysis of variance with Bonferroni correction.ResultsForty-six patients were included of whom 37 (80%) underwent complete DMR and 36 were finally analysed; in remaining patients, mainly technical issues were observed. Twenty-four patients had at least one AE (52%) related to DMR. Of these, 81% were mild. One SAE and no unanticipated AEs were reported. Twenty-four weeks post DMR (n=36), HbA1c (−10±2 mmol/mol (−0.9%±0.2%), p<0.001), FPG (−1.7±0.5 mmol/L, p<0.001) and HOMA-IR improved (−2.9±1.1, p<0.001), weight was modestly reduced (−2.5±0.6 kg, p<0.001) and hepatic transaminase levels decreased. Effects were sustained at 12 months. Change in HbA1c did not correlate with modest weight loss. Diabetes treatment satisfaction scores improved significantly.ConclusionsIn this multicentre study, DMR was found to be a feasible and safe endoscopic procedure that elicited durable glycaemic improvement in suboptimally controlled T2D patients using oral glucose-lowering medication irrespective of weight loss. Effects on the liver are examined further.Trial registration number NCT02413567

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Aged / Blood glucose / Blood Glucose - metabolism / Body mass index / Body weight loss / Catheters / Clinical medicine / Diabetes / diabetes mellitus / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - blood / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - surgery / Diet / duodenal mucosa / Duodenoscopy - methods / Duodenum / Duodenum - surgery / Endoscopic Mucosal Resection - adverse effects / Endoscopic Mucosal Resection - methods / endoscopic procedures / Endoscopy / Feasibility Studies / Female / Gastrointestinal surgery / Glucose / glucose metabolism / Glycated Hemoglobin A - metabolism / Homeostasis / Hospitals / Humans / Hypoglycemia / Hypoglycemic Agents - therapeutic use / Insulin / Intestinal Mucosa - surgery / Liver / Male / Metabolism / Middle Aged / Mucosa / Patient Satisfaction / Patients / Physiology / Prospective Studies / Studies / Surgery / therapeutic endoscopy / Transaminase / Weight control