There is a worldwide pandemic of type 2 diabetes (T2D) and obesity (1). In clinical practice, many patients with obesity have poor glycemic management despite diet and lifestyle advice and maximal medications (2–4). In this situation, Roux-en-Y gastric bypass is highly effective, and increased use of bariatric surgery has been recommended (2). Nevertheless, it is an invasive and irreversible surgical procedure. EndoBarrier (GI Dynamics, Boston, MA), also known as duodenal-jejunal bypass liner, is a 60-cm impermeable fluoropolymer sleeve that is implanted endoscopically into the upper part of the small intestine (2–4), left in place for up to 1 year, and then removed endoscopically. The duodenal-jejunal bypass liner was developed to mimic the proposed small-bowel mechanisms of Roux-en-Y gastric bypass (2–4) while being less invasive. In Europe in 2017, approval for use (certificate of Conformité Européenne, or CE mark) of EndoBarrier was not renewed for reasons that are not entirely clear (3,4). As over 3,000 patients have been treated with EndoBarrier worldwide, during 2017, an independent, secure, online registry was established by the Association of British Clinical Diabetologists (ABCD) for the collection of safety and efficacy data of EndoBarrier-treated patients worldwide.
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