Implantation of a duodenal–jejunal bypass sleeve for managing obesity

3 The procedure

3.1 Endoscopic implantation of a duodenal–jejunal bypass sleeve (DJBS) is a minimally invasive procedure that has been used to promote weight loss in patients with obesity and with a view to improving comorbidities, including diabetes.

3.2 The procedure is done with the patient under general anaesthesia or sedation, using image guidance. The sleeve is positioned endoscopically (via the mouth). Using a delivery catheter, a capsule containing a single-use impermeable DJBS is positioned in the duodenal bulb just distal to the pylorus and is secured there using an integral spring metal anchor. The sleeve is advanced distally into the jejunum with the aid of a tension wire which is part of the introducer device. It extends approximately 60 cm down the small intestine and forms a barrier between food and the intestinal wall, delaying the mixing of digestive enzymes with the food.

3.3 After the procedure, patients are placed on a diet that typically involves progression from fluids to semi-solid foods, before returning to solid foods.

3.4 After a maximum of a year, the sleeve is removed under sedation, using endoscopy and image guidance. The anchor incorporates a drawstring mechanism that enables it to be collapsed and partly withdrawn into a plastic hood fitted to the endoscope. The entire device is then withdrawn.