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Benefits and risks

Benefits and risks

When NICE looked at the evidence, it decided that there is not enough evidence to be sure about how well an implanted duodenal–jejunal bypass liner works or how safe it is for managing type 2 diabetes. The 8 studies that NICE looked at involved a total of 186 patients.

Generally, they showed the following minimal benefits:

  • a 1% fall in HbA1c levels at 6 months

  • slightly improved blood sugar levels at 6 months after the liner was removed

  • slight fall in blood pressure at 1 year

  • reduced total cholesterol and triglycerides at 1 year

  • improvement in insulin resistance at 6 months

  • a decrease in the amount of insulin and antidiabetic medicine used at 1 year

  • successful insertion of the liner in 96% of patients (in 4%, the liner was difficult to insert)

  • no differences in most outcomes at 1 year between the procedure plus diet and diet alone.

The studies showed that the risks of an implanted duodenal–jejunal bypass liner included:

  • early removal of the liner because of problems (pain, bleeding in the gut and movement of the liner) in 25–40% of patients

  • pancreatitis in 2 patients

  • pain and other minor symptoms in the digestive tract in 63% of patients

  • nausea and vomiting in 24% of patients

  • liner-related back pain in 23% of patients

  • mild-to-moderate low blood sugar in 24% of patients (but this was similar in patients without the liner)

  • metabolic and nutritional disorders in 61% of patients

  • a hole in the bowel in 1 patient; the liner was removed and the damage repaired surgically

  • a hole in the food pipe while the liner was being removed in 1 patient, which needed treatment and healed after 3 weeks.

NICE was also told about some other possible risks: difficulties in inserting the liner; having to stop the procedure because of food left in the stomach; cramping; intussusception (an emergency when 1 part of the gut slides into the next part); misplacement of the liner hood or blockage at the top of the throat while the liner is being removed.

If you want to know more about the studies, see the guidance. Ask your health professional to explain anything you don't understand.

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