Duodenal Metallic Bypass Sleeve for Nutrient Malabsorption to Suppress Body Weight Gain in a Porcine Model

다국어 초록 (Multilingual Abstract)

Background and Purpose: Endoscopic bariatric and metabolic therapies are minimally invasive alternatives that bridge the gap between pharmacological treatment and bariatric surgery. A novel duodenal metallic bypass sleeve (DMBS) was developed to induce nutrient malabsorption while preserving ampullary patency and modulating incretin hormones. This study aimed to evaluate the technical feasibility, safety, and efficacy of the DMBS to suppress weight gain in a porcine model. Materials and Methods: The DMBS consisted of a disk-part, a sleeve-part, and four connecting wires. The characteristics of the DMBS were analyzed. Twelve pigs were randomly assigned to the control, DMBS@4wks, rebounding, and DMBS@8wks groups (n = 3 per group). The efficacy and safety of the DMBS were assessed by comparing the results of weight changes, follow-up radiological and endoscopic, hematologic, and histological examination. Results: DMBS placement and removal were technically successful in all study groups. The mean percentage of total body weight gain (%TBWG) in the DMBS-treated groups were significantly lower than that in the control group (all p < 0.05). The mean %TBWGs at 8 weeks were 51%, 46%, and 29% in the control, rebounding, and DMBS@8wks groups, respectively. DMBS-induced tissue hyperplasia and mucosal injury markers were significantly increased. In the DMBS-treated groups, increased glucose transporter type 1 (GLUT1) and glucagon-like peptide-1 (GLP-1) and decreased glucose-dependent insulinotropic peptide (GIP) levels were observed. Conclusion: The DMBS was technically feasible, effective, and safe in suppressing weight in the porcine model. This device seems to be a novel, minimally invasive endoscopic bariatric therapeutic option for obesity management. (Key words: Nutrient absorption, Glucose-dependent insulinotropic peptide, Glucagon-like peptide-1, Stent, Obesity)

목차 (Table of Contents)

• ABSTRACT i
• CONTENTS iii
• LIST OF FIGURES iv
• LIST OF TABLES v
• LIST OF ABBREVIATIONS vi
• INTRODUCTION 1
• MATERIALS AND METHODS 3
• 1. Preparation of the duodenal metallic bypass sleeve (DMBS) 3
• 2. Characterization of the DMBS 4
• 3. Animal study design 5
• 4. DMBS placement and removal 6
• 5. Follow-up radiological and endoscopic examinations 7
• 6. Weight changes and hematologic examination 8
• 7. Histological examination 9
• 8. Immunohistochemical examination 10
• 9. Immunofluorescence examination 11
• 10. Statistical analysis 12
• RESULTS 13
• 1. Characterization of the DMBS 13
• 2. Procedural outcomes and adverse events of the DMBS 15
• 3. Follow-up radiographic and endoscopic findings 18
• 4. Weight changes and hematological findings 21
• 5. Histological findings 25
• 6. GLUT1, GIP and GLP-1 analysis 30
• DISCUSSION 33
• CONCULSION 37
• REFERENCE 38
• 국문요약 43