During the SAGES emerging technologies session, which to us was like an early Christmas, Dr. Dmitry Nepomnayshy presented his experience using the EndoBarrier, an endoscopically-deployed impermeable tube that is placed in the duodenum to prevent absorption.

Two patients have received the full treatment so far; within twelve weeks, one lost 11 pounds and the other 26 pounds. Neither reported making crinkly plastic wrapper sounds upon leaning forward.

To place the device, the patient is scoped, and the tube is deployed in the duodenal bulb under fluoroscopic guidance. Small barbs attached to the proximal portion of the device keep it in place. A blunt wire attached to the distal end is advanced through the small intestine until the tube is extended its entire length. The process takes about half an hour.

According to Dr. Nepomnayshy, bile and pancreatic enzymes pass along the outside of the tube, and food is completely prevented from contacting the duodenal mucosa.

After twelve weeks, the device is removed. Not surprisingly, some granulation tissue is found around the barbs, and bile stains are visible along the tube’s surface: 

According to Dr. Nepomnayshy, removal takes about ten minutes, and the mucosal irritation resolves within two weeks.

A controlled study using sham endoscopies indicated that patients could not feel the tube inside of them, nor did they experience any change in appetite or time to onset of satiety. Dr. Nepomnayshy reports that some patients had duodenal bulbs that were too small for the barbed region of the device, but he said that in his small sample there were no issues with obstruction, bleeding, or infection.

Since it’s clear that every single person in the United States will soon be obese, this seems like a solution that is somewhere between a diet and a Roux-en-Y with respect to both efficacy and invasiveness. Of course more patients will have to receive the device before its safety can be established, but so far it seems like a promising idea.