SFEEU2017 Obesity Update Oral Communications (8 abstracts)
One year efficacy, safety and tolerability outcomes of endoscopic proximal intestinal exclusion therapy using the Endobarrier device: institution of the UK’s first National Health Service Endobarrier service for type 2 diabetes and obesity
Piya Sen Gupta , Mahender Yadagiri , Susan Irwin , Wyn Burbridge , Hardeep Gandhi , Rachel Alden , John Bleasdale , Ed Fogden , Mark Anderson & Bob Ryder
City Hospital, Birmingham, UK.
Introduction: Our institution leads a UK, multicentre, randomised controlled trial (REVISE-Diabesity ISRCTN00151053) investigating the interaction of Endobarrier therapy, a 60 cm endoscopically implanted proximal intestinal liner, with glucagon-like peptide-1 drug therapy.
Aims: To evaluate whether acquired experience could translate into establishment of an effective and safe NHS Endobarrier service in patients with diabesity.
Methods: We initiated: i) an NHS Endobarrier service for patients with suboptimally controlled type 2 diabetes and obesity ii) a secure online registry to monitor outcomes.
Results: Since service initiation (October 2014), 46/118 (39.0%) referred have been accepted for treatment. Twenty-five patients have so far completed 1-year’s Endobarrier treatment (age 51.9±7.5 years, 56.0% male, 44.0% Caucasian, diabetes duration 12.0(8.5–21.0) years, 60.0% insulin-treated, BMI 41.1±8.9 kg/m2). Mean(±S.D.) HbA1c fell by 24.8±25.0 mmol/mol from 81.2±24.7 to 56.4±11.5 mmol/mol (P<0.001), weight fell by 16.3±10.0 kg from 118.5±27.7 to 102.2±28.2 kg (P<0.001), systolic blood pressure from 137.7 to 126.0 mmHg (P=0.006) and ALT from 32.0±20.5 to 17.4±9.8 U/l (P<0.001). In the 15 patients on insulin median (IQR) total daily insulin dose reduced from 104(60–135) to 12(0–65)units (P=0.003) with 6/15 (40%) discontinuing insulin. Two patients had gastrointestinal haemorrhage having not complied with mandatory avoidance advice. There was one liver abscess. Early removal led to resolution in these cases. 93.8% patients would be extremely likely to recommend this service to friends and family.
Conclusion: This inaugural NHS service demonstrates Endobarrier to be highly effective in patients with refractory diabesity, with high patient satisfaction levels and an acceptable safety profile. As endoscopy units are ubiquitous, our service could be readily disseminated, with the registry useful for on-going monitoring nationwide.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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