Efficacy and Safety of the Gastric Bypass Stent System on Body Weight and Metabolic Parameters in Obese Patients
Condition: Obesity
MeSH terms: Body Weight
Study type: Interventional

Summary: 
      In this study, the investigators use a novel endoscopic duodenal-jejunal bypass liner-the
      Gastric Bypass Stent System (Hangzhou Tangji Medical Technology Co., Ltd., China) for the
      treatment of obesity. The aim of this study is to evaluate the efficacy and safety of this
      new device on weight loss and obesity-associated metabolic parameters.
    

Detailed description: 
      This is a prospective, open-label, single-arm study conducted at the department of
      gastroenterology, Beijing Friendship Hospital, Capital Medical University in China. In this
      study, all the participants were implanted with the Gastric Bypass Stent System. The device
      had an intended implantation time of 12 weeks, and the participants were followed up for 24
      weeks. Both the implantation and explantation were conducted under general anesthesia. A
      liquid diet was required for a week after implantation to reduce the risk of early
      obstruction or migration. All the participants received an oral proton pump inhibitor twice
      daily during the implantation and within 4 weeks of removal. Primary outcomes were changes in
      excess weight loss and total weight loss at 12 and 24 weeks. Secondary outcomes included
      changes in body weight, body mass index (BMI), insulin resistance, liver enzymes, lipids and
      uric acid at 12 and 24 weeks, and device safety. At the first visit, baseline demographics,
      medical history, physical examination and laboratory tests were collected. The subjects were
      scheduled for follow-up visit at 1, 4, 12, 16 and 24 weeks. At each visit, body weight was
      measured and symptoms were recorded. Blood and fecal samples were collected to observe the
      changes of metabolic parameters and also to monitor the adverse effects. A complete blood
      count, liver function, blood glucose, insulin, HbA1C, lipids, uric acid, amylase, iron tests
      and fecal occult blood were partially or all measured at each visit. Insulin resistance was
      assessed by the homeostasis model assessment of insulin resistance (HOMA-IR), a value ≧2.69
      was considered as insulin resistance. Elevated ALT or AST was considered as abnormal liver
      enzymes. Primary outcomes were changes in EWL and TWL at 12 and 24 weeks. Secondary outcomes
      included changes in body weight, BMI, insulin resistance, liver enzymes, lipids, UA at 12 and
      24 weeks, and device safety.Analyses were conducted with IBM SPSS Statistics for Windows,
      version 22.0 (IBM Corporation , Armonk, NY). Data was reported as mean ± standard deviation
      (SD) . A p value of <0.05 was considered statistically significant. Analyses of body weight
      changes between different time points were conducted with a paired sample t test. Analyses of
      metabolic parameters in the blood were calculated by generalized estimating equations (GEE)
      because of the existence of missing values.
    

Intervention name(s): the Gastric Bypass Stent System
Intervention type(s): Device
Intervention description(s): The Gastric Bypass Stent System is a newly designed endoscopic duodenal-jejunal bypass liner for the treatment of obesity by Hangzhou Tangji Medical Technology Co., Ltd.. It consists of three main parts: a 60-cm polyethylene sleeve fixed into the duodenal bulb by anchors with barbs, a delivery system and a retrieval system. Compared to the Endobarrier, it has several technical adjustments. First, it improved sleeve materials to provide better barrier properties and reduce the breeding of bacteria resulting in hepatic abscess. Second, the barbs on the anchoring system have been modified to reduce duodenal injury. Third, the delivery and retrieval system have been optimized to eliminate the need of fluoroscopic guidance during implantation and explantation.
Intervention model: Single Group Assignment
Intervention model description: placement of the Gastric Bypass Stent System
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: The Gastric Bypass Stent System; total weight loss; excess weight loss; obesity