Maintenance of efficacy after duodenal– jejunal bypass liner explantation in the first NHS EndoBarrier service


  • Robert EJ Ryder Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, UK
  • Mahi Yadagiri
  • Susan P Irwin
  • Wyn Burbridge
  • Hardeep Gandhi
  • Rachael A Allden
  • John P Bleasdale
  • Edward N Fogden
  • Mark R Anderson
  • Piya Sen Gupta



diabetes, obesity, diabesity, EndoBarrier, bariatric surgery


EndoBarrier®, a 60 cm endoscopically implanted proximal intestinal liner, reduces weight and HbA1c over 1 year. We report the outcomes of the first 12 patients who completed 6 months post EndoBarrier removal in the first NHS EndoBarrier service. All patients were obese (body mass index 41.7±9.8 kg/m2) with diabetes for 10–25 years and 75% were on insulin therapy. All patients (age 52.4±9.3 years) were advised to institute behavioural changes during the implant period (1 year) and maintain them thereafter. Implantation of EndoBarrier for 1 year reduced weight (17.6±8.9 kg, p<0.001), HbA1c (26.7±20.8 mmol/mol, 2.4±1.9%, p=0.001), systolic blood pressure (14.1±16.1 mmHg, p=0.011) and median total daily insulin dose from 104 to 48 Units/day (p=0.024) (n=9). Six months post EndoBarrier removal, 75% of patients sustained the metabolic improvement achieved with EndoBarrier; insulin dose requirement continued to fall and four of the nine insulin-treated patients discontinued insulin. Of the three patients whose weight/glycaemic control worsened, two had depression and one became immobile after explantation due to ill health unrelated to EndoBarrier treatment. Most (93.8%) of our patients stated that they would be extremely likely to recommend our service to friends and family. These data are encouraging for wider establishment of NHS EndoBarrier services.

Author Biography

Robert EJ Ryder, Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, UK

Dr Bob Ryder
Chief investigator ABCD REVISE-Diabesity and End-OSA Studies with Endobarrier
Clinical lead, ABCD audits of new diabetes therapies
Consultant Diabetologist
City Hospital
Dudley Road
Birmingham B18 7QH


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