• Natascha Roehlen, Katharina Laubner, Leonard Nicolaus, Henning Schwacha, Dominik Bettinger, Andreas Krebs, Robert Thimme, and Jochen Seufert.
• Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Berta-Ottenstein Program, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Division of Hepatology, Gastroenterology and Gastrointestinal Endoscopy, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
• Nutrition. 2022 Nov 1; 103-104: 111806.

ObjectivesNon-alcoholic fatty liver disease (NAFLD) represents an excessively rising entity of chronic liver disease and is a leading cause of mortality among patients with metabolic syndrome. The duodenal-jejunal bypass liner (DJBL) is a minimally invasive endoscopic treatment option for patients with obesity and type 2 diabetes (T2DM). Although beneficial effects of DJBL therapy on body weight reduction and glycemic control have been described, the effects of DJBL implantation on NAFLD is unknown. The aim of this study was to to evaluate the effects of DJBL implantation for 6 to 9 months on biochemical and clinical biomarkers of NAFLD in a large cohort of patients.MethodsThe effect of DJBL treatment on biochemical and clinical parameters of NAFLD were assessed in a study cohort of 71 patients with obesity and T2DM. DJBL was implanted for 9 to 12 months and patients were regularly monitored during the implantation period and for a follow-up period of 6 months after explantation.ResultsDJBL therapy was associated with a significant decrease in fatty liver index during time of implantation (explantation versus implantation: 93.38 versus 98.22, P < 0.001). Moreover, DJBL implantation was associated with decreases of alanine aminotransferase (29.03 versus 42.29 U/L, P < 0.0001) and cytokeratin-18 fragments (CK18 MF30; 190.6 versus 276 U/L, P < 0.0001), that further remained stable during 6 months after explantation. NAFLD fibrosis and aspartate aminotransferase-to-platelet ratio index (APRI) scores decreased significantly during implantation (-0.83 versus 0.19, P < 0.001, 0.26 versus 0.36, P < 0.0001, respectively).ConclusionsTo our knowledge, this is the first study to demonstrate significant effects of DJBL treatment on biochemical and clinical markers of NAFLD activity. Significant effects of DJBL treatment on NAFLD fibrosis and APRI score further suggests protective effects of DJBL on liver-related morbidity and mortality in patients with obesity and T2DM.Copyright © 2022 Elsevier Inc. All rights reserved.

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