Effect of the EndoBarrier Gastrointestinal Liner on obesity and type 2 diabetes: Systematic review and meta-analysis

In contrast to bariatric surgery, less invasive and reversible techniques to counteract obesity and type 2 diabetes (T2D) have been developed, including the EndoBarrier Gastrointestinal Liner (duodenal-jejunal bypass sleeve (DJBS)). We conducted a systematic review with meta-analyses of eligible trials to evaluate the efficacy and safety of DJBS. Five randomized controlled trials (n = 235 subjects) and 10 observational studies (n = 211 subjects) were included. Risk of bias was evaluated as high in all studies. Mean body mass index ranged from 30 to 49.2 kg/m(2) and 10-100% of the subjects had T2D. Meta-analysis showed that DJBS was associated with significant mean differences (MDs) in body weight and excess weight loss of -5.1 kg (95% confidence interval (CI): -7.3,-3.0; 4 trials; n = 151; I(2) =37%) and 12.6% (CI: 9.0,16.2; 4 trials; n = 166; I(2) =24%), respectively, compared to diet. MDs in HbA1c (-0.9%; CI: -1.8,0.0) and fasting plasma glucose (-3.7 mM; CI: -8.2,0.8) among T2D subjects did not reach statistical significance. Adverse events consisted mainly of abdominal pain, nausea and vomiting. No deaths occurred. Future high-quality long-term RCTs are needed to assess efficacy and safety further.