WASHINGTON — Researchers are piloting a procedure that employs endoscopically placed intragastric magnets to remodel the small intestine. The novel bypass surgery is aimed at increasing glucose response in people with type 2 diabetes, according to a speaker at ObesityWeek.
The magnets are used to create a side-to-side intestinal anastomosis for intestinal diversion, said Christopher
C. Thompson, MD, MSC, director of therapeutic endoscopy at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School.
Delivered under general anesthesia deep into the small bowel through a colonoscope, and manipulated laparoscopically by the surgeon, the magnets couple to compress formerly distant parts of the intestine. Over several days, necrosis creates a new opening allowing food and bile to bypass part of the intestine where incretin inhibitors are secreted.
“Then the magnets will pass out of the body in the fecal stream, and you’re left with a side-to-side anastomosis,” Thompson said.
In a single-center study conducted in Europe, Thompson and colleagues performed the procedure on 10 patients: three without diabetes, three with prediabetes and four with type 2 diabetes.
At 12 months, the anastomosis remained without becoming smaller. Mean HbA1c decreased among the diabetes group from 7.8% at baseline to 5.9%, and among the prediabetes group from 6.1% at baseline to 5.1%. Patients had discontinued all or some of the anti-diabetes medications they had taken at baseline, according to Thompson.
Weight also decreased from baseline at 12 months, for a mean total weight loss of 14.6% and mean excess weight loss of 40.2%. Although 2-year data are not yet available, weight loss appears to have continued after 12 months and plateaued by 24 months, Thompson said.
“Small bowel mechanisms are related to the development of obesity and type 2 diabetes. Endoscopic procedures, surgeries, are targeting these mechanisms, and proving to be effective managing these conditions,” Thompson said. “Magentic anastomosis seems promising, and further long-term studies are underway.” — by Jill Rollet
Machytka E, et al. Gastrointest Endosc. 2017;doi:10.1016/j.gie.2017.07.009.
Thompson CC. Intestinal magnets. Presented at: ObesityWeek 2017; Oct. 29-Nov. 2, 2017; Washington, D.C.
Disclosure: Thompson reports he is a consultant, serves on the advisory board, provides research support or owns stock in Apollo, Boston Scientific, Fractyl Labs, GI Dynamics, GI Windows, Olympus and USGI Medical.