Duodenal Mucosal Resurfacing

A minimally invasive procedure for diabetics to control blood sugar levels.

Duodenal Mucosal Resurfacing

Type-2 diabetes is a metabolic disorder and many treatments including lifestyle modifications and oral or injectable medications, have been sorted out to manage this condition better. Despite a wide choice of options, the patient’s blood sugar is not controlled well, and the medication has its own side effects in the long run. But now, a new approach has been adapted to correct the metabolic disorder and reduce the blood sugar with the help of a procedure called “Duodenal Mucosal Resurfacing”. It is a minimally invasive procedure after which the patient can leave on the same day.

Type-2 diabetes is caused by various factors, of which, nutrient absorption, hormone-producing cell population, abnormalities in the duodenal mucosa are thought to have a pathophysiological role. Duodenum, the first part of the small intestine, is where the absorption of nutrients begins and the hormones that control blood glucose levels are produced.

Duodenal mucosal ablation safely alters the inner surface of the duodenum, which changes the absorption of nutrients and intake of glucose levels, thereby improving the control of blood sugar levels.

  • About the procedure +

    Duodenal mucosal ablation is a safe and effective metabolic treatment used for patients with type 2 diabetes, whose blood sugar is not well controlled by oral medications. It is a catheter-based endoscopic procedure that uses heat to remove the excessive layer of the duodenum. After the procedure, the body heals itself, to form a healthy layer of duodenal lining.

    The duodenal mucosal ablation reduces the absorption of nutrients and results in the improvement of blood sugar levels in patients with type 2 diabetes. Also, a significant improvement can be observed within two years after the procedure.

  • Patient selection +

    Duodenal mucosal ablation is indicative in a patient with Type 2 diabetes, of age between 28-75 years, and a body mass index (BMI) of 24-40 kg/m2.

    It is not recommended in the people with the following:

    • type 1 diabetes
    • history of hyperglycemia due to autoimmune disease
    • previous gastrointestinal surgery
    • history of acute or chronic pancreatitis
    • upper bowel bleeding
    • active hepatitis
    • history of duodenal inflammatory diseases
    • pregnancy

  • Before the procedure +

    The patient is evaluated by clinical examination and by review of medical history. Certain diagnostics tests are also recommended such as fasting glucose, fasting insulin, glycosylated hemoglobin, urine albumin, etc. The patient can be asked to discontinue certain medications such as anticoagulants, non-steroidal inflammatory drugs, prior to the day of performing the procedure. It is essential for a patient to inform the doctor about any allergies or underlying conditions.

    Before starting the procedure, the blood pressure and the blood sugar of the patient are evaluated, and he/she is also briefed about the procedure. General anesthesia is given to make the patient unconscious and perform the procedure, without causing any discomfort or pain, while inserting the endoscope through the mouth.

  • During the procedure +

    The procedure is performed under sedation for comfort, after an overnight.

    For duodenal mucosal ablation, an endoscope is first passed through the mouth, and eventually into the duodenum. Once inside the duodenum, the papilla (a round projection that secretes bile and other digestive enzymes) is identified with the help of an endoscope and a clip is placed near it. Now, the endoscope guides a wire along the duodenum and a special catheter is also introduced.

    The catheter has an inflatable hot balloon at the end. A saline solution is injected into the mucosa to separate it from the other layers of the duodenum. The mucosa is then subjected to thermal ablations for a specific duration. Finally, an endoscope and catheter are removed through the mouth. After the procedure, the patient can be discharged on the same day.

  • After procedure care +

    The procedure approximately takes 90 minutes. After the procedure, the patients are advised to follow a two-week liquid diet, then followed by a semi-solid diet, which can be gradually shifted to solid food at the end of the month. Usually, the antidiabetic medications are not altered, except when medically indicated. The patient can resume normal life after a few days of the procedure. Follow-up until one year is necessary for dietary and medical counseling to identify any ill effects such as hypoglycemia (low blood sugar) and also to check the health status of the individual.

  • What a patient can expect? +

    Duodenal mucosal ablation has enabled patients with type-2 diabetes to treat their condition without having to undergo surgical interventions that have complications. It is performed as an outpatient treatment, without making any incision, which ensures a faster recovery period and no risk of scars, pain, and infections. The procedure can also reduce the dependence on oral medications used for controlling blood sugar levels. Also, the amount of fat in fatty liver can be reduced.

     

    References

    https://www.endocrinologyadvisor.com/home/topics/diabetes/type-2-diabetes/single-endoscopic-procedure-may-improve-control-of-type-2-diabetes/

    https://www.sciencedirect.com/topics/immunology-and-microbiology/duodenum-mucosa

    https://care.diabetesjournals.org/content/39/12/2254

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