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van Baar ACG, Devière J, Hopkins D, Crenier L, Holleman F, Galvão Neto MP, Becerra P, Vignolo P, Rodriguez Grunert L, Mingrone G, Costamagna G, Nieuwdorp M, Guidone C, Haidry RJ, Hayee B, Magee C, Carlos Lopez-Talavera J, White K, Bhambhani V, Cozzi E, Rajagopalan H, J G H M Bergman J. Durable metabolic improvements 2 years after duodenal mucosal resurfacing (DMR) in patients with type 2 diabetes (REVITA-1 Study). Diabetes Res Clin Pract 2022; 184:109194. [PMID: 35032562 DOI: 10.1016/j.diabres.2022.109194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/10/2021] [Accepted: 01/04/2022] [Indexed: 12/18/2022]
Abstract
AIMS Duodenal mucosal resurfacing (DMR) is an endoscopic procedure developed to improve metabolic parameters and restore insulin sensitivity in patients with diabetes. Here we report long-term DMR safety and efficacy from the REVITA-1 study. MATERIALS AND METHODS REVITA-1 was a prospective, single-arm, open-label, multicenter study of DMR feasibility, safety, and efficacy in patients with type 2 diabetes (hemoglobin A1c [HbA1c] of 7.5-10.0% (58-86 mmol/mol)) on oral medication. Safety and glycemic (HbA1c), hepatic (alanine aminotransferase [ALT]), and cardiovascular (HDL, triglyceride [TG]/HDL ratio) efficacy parameters were assessed (P values presented for LS mean change). RESULTS Mean ± SD HbA1c levels reduced from 8.5 ± 0.7% (69.1 ± 7.1 mmol/mol) at baseline (N = 34) to 7.5 ± 0.8% (58.9 ± 8.8 mmol/mol) at 6 months (P < 0.001); and this reduction was sustained through 24 months post-DMR (7.5 ± 1.1% [59.0 ± 12.3 mmol/mol], P < 0.001) while in greater than 50% of patients, glucose-lowering therapy was reduced or unchanged. ALT decreased from 38.1 ± 21.1 U/L at baseline to 32.5 ± 22.1 U/L at 24 months (P = 0.048). HDL and TG/HDL improved during 24-months of follow-up. No device- or procedure-related serious adverse events, unanticipated device effects, or hypoglycemic events were noted between 12 and 24 months post-DMR. CONCLUSIONS DMR is associated with durable improvements in insulin sensitivity and multiple downstream metabolic parameters through 24 months post-treatment in type 2 diabetes. Clinical trial reg. no. NCT02413567, clinicaltrials.gov.
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Affiliation(s)
- Annieke C G van Baar
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Jacques Devière
- Gastroenterology, Erasme UnCiversity Hospital, Brussels, Belgium
| | - David Hopkins
- Institute of Diabetes, Endocrinology, and Obesity, King's Health Partners, London, UK
| | - Laurent Crenier
- Department of Endocrinology, Erasme University Hospital, Brussels, Belgium
| | - Frits Holleman
- Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Pablo Becerra
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | - Paulina Vignolo
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | | | - Geltrude Mingrone
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Max Nieuwdorp
- Internal and Vascular Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Caterina Guidone
- Internal Medicine, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
| | - Rehan J Haidry
- Department of Gastroenterology, University College Hospital, London, UK
| | - Bu Hayee
- Institute of Diabetes, Endocrinology, and Obesity, King's Health Partners, London, UK
| | - Cormac Magee
- Department of Gastroenterology, University College Hospital, London, UK; Center for Obesity Research, Department of Medicine, University College London, London, UK
| | | | - Kelly White
- Fractyl Laboratories Inc, Lexington, MA, USA
| | | | - Emily Cozzi
- Fractyl Laboratories Inc, Lexington, MA, USA
| | | | - Jacques J G H M Bergman
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands.
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van Baar AC, Haidry R, Rodriguez Grunert L, Galvao MPN, Bisschops R, Hayee BH, Costamagna G, Deviere J, Bergman JJ. Duodenal mucosal resurfacing: Multicenter experience implementing a minimally invasive endoscopic procedure for treatment of type 2 diabetes mellitus. Endosc Int Open 2020; 8:E1683-E1689. [PMID: 33140025 PMCID: PMC7581486 DOI: 10.1055/a-1244-2283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background and study aims Duodenal mucosal resurfacing (DMR) is an endoscopic procedure which improves insulin resistant metabolic disease, including type 2 diabetes mellitus (T2DM). The aim of this report was to evaluate the feasibility and procedural aspects of DMR and to provide more specific DMR procedural guidance for endoscopists. Patients and methods In this international multicenter, prospective, open-label study, patients on oral anti-diabetic agents for treating T2DM underwent single DMR. DMR entails circumferential submucosal lifting followed by circumferential mucosal hydrothermal ablation using an over-the-guidewire balloon catheter for lifting and ablation. For the first 28 patients a dual catheter system was used. During the study, a new integrated catheter was developed which was used for the latter 18 patients. During DMR, procedure success (complete DMR: duodenal ablation length ≥ 9 cm) and procedure duration were captured. Results Forty-six patients underwent DMR. Using the dual catheter system, a complete DMR was performed in 22 of 28 patients (79 %). In the next eighteen patients who underwent DMR with the integrated catheter, a complete DMR was performed in 15 of 18 patients (83 %). The integrated catheter facilitated the DMR procedure and resulted in a reduction in procedure time. A detailed table and video are provided for future endoscopists. Conclusions In our multicenter study, DMR was found to be feasible in the hands of experienced endoscopists. The integrated DMR catheter was a welcome modification during the study, allowing for easier ablation administration. Further optimization of the technique would be valuable prior to widespread dissemination.
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Affiliation(s)
- Annieke C.G. van Baar
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Rehan Haidry
- Gastroenterology, University College Hospital, London, UK
| | | | - Manoel P. Neto Galvao
- Bariatric Endoscopy service, Endovitta Institute, Sao Paulo, Brazil,Surgery, FMABC Medical School, Sao Paulo, Brazil
| | - Raf Bisschops
- Gastroenterology and Hepatology, Catholic University of Leuven, Leuven, Belgium
| | - Bu Hussain Hayee
- Institute of Therapeutic Endoscopy, King’s Health Partners, London, UK
| | - Guido Costamagna
- Digestive Endoscopy, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy,CERTT (Centre for Endoscopic Research Therapeutics and Training), Università Cattolica, Rome, Italy
| | - Jacques Deviere
- Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Jacques J.G.H.M. Bergman
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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van Baar ACG, Holleman F, Crenier L, Haidry R, Magee C, Hopkins D, Rodriguez Grunert L, Galvao Neto M, Vignolo P, Hayee B, Mertens A, Bisschops R, Tijssen J, Nieuwdorp M, Guidone C, Costamagna G, Devière J, Bergman JJGHM. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study. Gut 2020; 69:295-303. [PMID: 31331994 PMCID: PMC6984054 DOI: 10.1136/gutjnl-2019-318349] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/19/2019] [Accepted: 06/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes. Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure that has been shown to improve glycaemic control in people with type 2 diabetes mellitus (T2D) irrespective of body mass index (BMI) changes. DMR involves catheter-based circumferential mucosal lifting followed by hydrothermal ablation of duodenal mucosa. This multicentre study evaluates safety and feasibility of DMR and its effect on glycaemia at 24 weeks and 12 months. METHODS International multicentre, open-label study. Patients (BMI 24-40) with T2D (HbA1c 59-86 mmol/mol (7.5%-10.0%)) on stable oral glucose-lowering medication underwent DMR. Glucose-lowering medication was kept stable for at least 24 weeks post DMR. During follow-up, HbA1c, fasting plasma glucose (FPG), weight, hepatic transaminases, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), adverse events (AEs) and treatment satisfaction were determined and analysed using repeated measures analysis of variance with Bonferroni correction. RESULTS Forty-six patients were included of whom 37 (80%) underwent complete DMR and 36 were finally analysed; in remaining patients, mainly technical issues were observed. Twenty-four patients had at least one AE (52%) related to DMR. Of these, 81% were mild. One SAE and no unanticipated AEs were reported. Twenty-four weeks post DMR (n=36), HbA1c (-10±2 mmol/mol (-0.9%±0.2%), p<0.001), FPG (-1.7±0.5 mmol/L, p<0.001) and HOMA-IR improved (-2.9±1.1, p<0.001), weight was modestly reduced (-2.5±0.6 kg, p<0.001) and hepatic transaminase levels decreased. Effects were sustained at 12 months. Change in HbA1c did not correlate with modest weight loss. Diabetes treatment satisfaction scores improved significantly. CONCLUSIONS In this multicentre study, DMR was found to be a feasible and safe endoscopic procedure that elicited durable glycaemic improvement in suboptimally controlled T2D patients using oral glucose-lowering medication irrespective of weight loss. Effects on the liver are examined further. TRIAL REGISTRATION NUMBER NCT02413567.
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Affiliation(s)
- Annieke C G van Baar
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Laurent Crenier
- Endocrinology, Erasme University Hospital, Brussels, Belgium
| | - Rehan Haidry
- Gastroenterology, University College Hospital, London, UK
| | - Cormac Magee
- Centre for Obesity Research, Department of Medicine, University College Hospital, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, UK
| | | | - Manoel Galvao Neto
- Bariatric Endoscopy Service, Gastro Obeso Center, Sao Paulo, Brazil,College of Medicine, Florida International University, Miami, Florida, USA
| | - Paulina Vignolo
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | | | - Ann Mertens
- Clinical and Experimental Endocrinology, Catholic University of Leuven, Leuven, Belgium
| | - Raf Bisschops
- Gastroenterology and Hepatology, Catholic University of Leuven, Leuven, Belgium
| | - Jan Tijssen
- Cardiology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Internal and Vascular Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Caterina Guidone
- Internal Medicine, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Roma, Italy
| | - Jacques Devière
- Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Jacques J G H M Bergman
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
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