Visual Abstract
EB, a 60cm endoscopically inserted proximal intestinal liner, reduces weight and HbA1c over 1 year. In the 1st NHS EB service, we provided EB to patients with sub optimally controlled diabesity and monitored outcomes in a registry. 45/62 (73%) completing 2 years post EB removal (age 51.4±7.7 years, 53% male, diabetes duration 14.4 (8-20) years, BMI 41.7±7.2 kg/m2) attended follow-up. During EB treatment, mean ± SD HbA1c fell by 1.9±1.8 %, from 9.2±1.8 to 7.3±1.0 % (p<0.001), weight by 17.3±8.9 kg from 122.5 ± 29.5 to 105.2±30.3 kg (<0.001), systolic BP from 138.9±14.1 to 126.1±14.8 mmHg (<0.001), serum alanine aminotransferase (marker of liver fat) from 30.2±17.0 to 19.0±11.2 U/L (p<0.001). Median (IQR) total daily insulin dose reduced from 109 (52-167) to 35 (0-63) units (n=30, p<0.001); 10/30 (33%) insulin treated patients discontinued insulin. 2-years post EB removal 33/45 (73%) maintained most of the improvement achieved with EB whilst 12/45 (27%) reverted to baseline (figure). Of those deteriorating, 11/12 (92%) had depression and/or bereavement and/or major health problems. 10/62 (16%) had early EB removal for adverse events or symptoms; all 10 fully recovered after removal and most derived significant benefit. Our data demonstrates EB as highly effective in patients with refractory diabesity, with maintenance of significant improvement 2 years after removal in 73%.
R. E. J. Ryder: Other Relationship; Self; Novo Nordisk. E. Fogden: None. P. Sen gupta: Other Relationship; Self; Napp Pharmaceuticals. M. Yadagiri: None. W. Burbridge: None. S. P. Irwin: None. T. Bashir: None. M. C. Wyres: None. J. Bleasdale: None. M. Anderson: None.
