Introduction: The duodenal-jejunal bypass liner (DJBL) is an antiresorptive endoscopic treatment option for type 2 diabetes (T2DM) and obesity. The effects of DJBL on cardiovascular risk parameters remain elusive.

Methods: We implanted in 71 patients with T2DM and metabolic syndrome a DJBL for 9-12 months. At implantation, 3 months, explantation, 3 and 6 months follow-up, data on blood sugar, body weight, blood pressure and lipid status were collected. Serum samples were analysed for dynamics of cardiovascular biomarkers: high sensitive CRP (HsCRP); lipoprotein-associated phospholipase A2 (Lp-PLA2); Homoarginine; symmetrical dimethylarginin (SDMA), assymetrical dimethylarginine (ADMA), and low densitiy lipoprotein (LDL) subfractions. Overall cardiovascular risk was estimated by Advanced-Risk-Engine at time of implantation, explantation and after 6 months of follow-up.

Results: Implantation of DJBL was accompanied by significant decrease of body weight and improvement of blood sugar. We observed decrements of systolic blood pressure, LDL and triglyceride levels in the course of DJBL implantation (p=1x10-3, p=2x10-3, p=0.01). hsCRP, Lp-PLA2 and small dense lipoprotein fraction LDL-4 showed significant decreases after implantation (hsCRP: V1 vs. V6, p=1x10-3, Lp-PLA2: V1 vs. V5, p<1x10-3,LDL-4: V1 vs. V5, p=0.04). Unexpectedly, decreased homoarginine levels after DJBL-implantation correlated with body weight reduction, possibly reflecting catabolic metabolism. Estimated overall cardiovascular risk by Advanced-Risk-Engine decreased after implantation and remained stable within 6 months of follow-up.

Discussion: Above recent reports of beneficial effects of DJBL on weight loss, glycemic control and lipid parameters in patients with metabolic syndrome, this is the first study that revealed significant impact on serological cardiovascular biomarkers, indicating possible protective effects of DJBL on cardiovascular outcome.


K. Laubner: Research Support; Self; Boehringer Ingelheim International GmbH, GI Dynamics, Inc. Speaker's Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Novartis AG. N. Röhlen: None. D. Bettinger: None. H. Hilger: None. C. König: None. A. Krebs: None. J. Seufert: None.


GI Dynamics

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