3 The procedure
3.1 Endoscopic implantation of a duodenal–jejunal bypass liner (DJBL) is a procedure that aims to improve glycaemic control in people with obesity or who are overweight.
3.2 The procedure is done with the patient under general anaesthesia or sedation, using image guidance. The liner is positioned endoscopically (via the mouth). Using a delivery catheter, a capsule containing a single‑use impermeable DJBL is positioned in the duodenal bulb just distal to the pylorus. It is secured there using an integral spring metal anchor. The liner is advanced distally into the jejunum using a tension wire that is part of the 'introducer' device. It extends about 60 cm down the small intestine and forms a barrier between food and the intestinal wall, delaying the mixing of digestive enzymes with food.
3.3 After the procedure, patients are recommended a diet that typically involves progression from fluids to semi‑solid foods and then to solid foods.
3.4 After a maximum of a year, the liner is removed with the patient under sedation, using image guidance and endoscopy. The anchor has a drawstring mechanism such that it can be collapsed and partly withdrawn into a plastic hood fitted to the endoscope before withdrawal.