Endobarrier is a 60cm intestinal liner inserted by mouth (endoscopy) to mimic weight-reducing and diabetes-improving gastric bypass surgery less invasively. The REVISE-Diabesity study has shown that treatment with the device can dramatically improve diabetes, obesity, fatty liver and cardiovascular risk, while having an acceptable safety record and high patient satisfaction levels. Having acquired the practical skills for inserting and removing Endobarriers, Sandwell & West Birmingham Hospitals (SWBH) NHS Trust set out to establish an NHS Endobarrier service for selected patients with 'diabesity' and 'nowhere else to go'. A one-year service evaluation found it is working well and referrals are increasing from across primary care and multiple secondary care specialties. There is a large number of NHS patients with diabesity who have exhausted treatment options, which suggests that the service could be established widely in the NHS.
UK spending on type 2 diabetes at £8.8bn will rise to £15.1bn by 2035 - and complication costs exceed treatment costs threefold. With sufficient weight loss, there is improved glycaemic control, but diets have not worked on a population-level and have a high individual failure rate. It is counterintuitive to use diabetes medications associated with weight gain (insulin, sulphonylureas) in obesity. Some agents, such as GLP-1 receptor agonists, reduce weight but 75% of patients do not respond sufficiently. Many are reluctant to try bariatric surgery, given its invasive nature. Such surgery has limited availability, is expensive and permanent.
To establish a fully operational effective, safe, innovative and cost-effective Endobarrier service for the benefi t of patients with diabesity in an NHS setting.
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