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Volume 7, Issue 6 (Suppl)
J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X
Page 65
December 07-08, 2017 Madrid, Spain
&
13
th
International Conference on Clinical Gastroenterology & Hepatology
2
nd
International Conference on Digestive Diseases
CO-ORGANIZED EVENT
Duodenal resurfacing procedure: Anovel approach for type 2 diabetes management
Mahir Kh Jallo
Gulf Medical University, UAE
B
ariatric surgery has emerged as an effective intervention to treat obesity and its related co morbidities. For multitude of
factors, access, insurance, patient fears, referrals and the procedures risks, only 1%of the eligible undergoes bariatric surgery.
Considerable needs for effective nonsurgical treatment modalities are mandated. The minimally invasive novel endoscopic
therapies with less morbidity could be the answer for many morbidly obese patients. Researches advocate the important role
of the foregut in the regulation of glucose homeostasis and diabetes. A novel purely endoscopic catheter-based procedure that
targets the duodenal mucosa had been developed by Fractyl Laboratories targeting the abnormal hypertrophy and hyperplasia
and the alterations in the enteroendocrine cells of the foregut usually seen in patients with diabetes. This minimally invasive
Duodenal Mucosal Resurfacing System DMR is known as Revita. Revita involves two main steps: First, creation of a protective
barrier by lifting the submucosal space of the duodenumwith endoscopic injection of saline and second, hydrothermal ablation
(recirculation of hot water within a balloon tipped catheter) of the circumferential duodenal mucosa. This rejuvenation of the
lining of the duodenum will change gut signaling in patients with metabolic diseases caused by insulin resistance. The early
results with Revita DMR are quite encouraging, with well tolerated procedure, concerning safety, three instances of duodenal
stenosis were reported, and treated using endoscopic balloon dilation. The first study involving 39 T2 DM who were failing
oral medications, at six months, the treatment had improved glycemic control, with significant decrease in FBG, PPG, and
HbA1c. The patients receiving DMR on a long segment (average ¼ 9.3 cm, n ¼ 28) compared to short (average 3.4 cm, n ¼ 11)
of the duodenum experienced a greater reduction in HbA1c levels at three months and achieved a reduction in HbA1c levels
from 8.5% to 7.1% at six months and about five pounds of weight loss. Further studies are necessary to understand the core
mechanism, long-term safety, efficacy, durability and how the procedure performs in a randomized clinical trial setting, while
also embracing the potential for wider metabolic benefits.
mahirjallo@hotmail.comJ Gastrointest Dig Syst 2017, 7:6(Suppl)
DOI: 10.4172/2161-069X-C1-059