A duodenal-jejunal bypass liner rapidly altered four appetite-regulating peptide hormones within one week, paralleling 12.7 kg of weight loss over 24 weeks in obese diabetic patients.
Hormonal changes within 1 weekPYY, ghrelin, and CCK levels changed significantly just 7 days after device placement — before substantial weight loss occurred — suggesting the hormonal shift drives weight loss rather than just reflecting it.
What the researchers found
A duodenal-jejunal bypass liner (DJBL) — a non-surgical sleeve placed in the upper intestine — produced 12.7 kg weight loss over 24 weeks while significantly altering appetite-regulating peptide hormones. Postprandial PYY increased from 2.6 to 4.1 nmol/L/min (p<0.05) and ghrelin from 7.8 to 11.0 ng/mL/min (p<0.05) within the first week. CCK response decreased from 434 to 229 pmol/L/min (p<0.01). Fasting leptin dropped from 98 to 53 ng/mL (p<0.01). These hormonal changes occurred rapidly (within 1 week) and persisted through 24 weeks.
Why it matters
This study reveals how bypassing the upper intestine reprograms the body's appetite peptide signaling. The rapid increase in PYY (a satiety peptide) and decrease in CCK suggest the hormonal changes drive weight loss rather than simply resulting from it. Understanding how gut anatomy shapes peptide hormone responses could lead to targeted therapies that mimic these hormonal changes without surgery or devices.
The numbers in context
n=17 · weight loss 4.3 kg at week 1, 12.7 kg at week 24 · PYY: 2.6→4.1→4.1 nmol/L/min · ghrelin: 7.8→11.0→10.6 ng/mL/min · CCK: 434→229→256 pmol/L/min · leptin: 98→53 ng/mL · all p<0.05 or better
How the study worked
A two-center prospective study enrolled 17 obese adults with type 2 diabetes who received the DJBL for 24 weeks. Fasting leptin and postprandial responses of PYY, CCK, and ghrelin were measured before implantation and at weeks 1 and 24. Meal responses were quantified as area under the curve values.
Who was studied
17 obese adults with type 2 diabetes (mean weight 116 kg) treated with DJBL for 24 weeks
What this study cannot tell us
Small sample size (n=17) with no control group, making it impossible to distinguish device-specific hormonal effects from weight loss-mediated changes. The lack of randomization or sham-device control limits causal inference. The DJBL has since been withdrawn from the market in some regions due to safety concerns (liver abscess risk). Long-term hormonal effects beyond 24 weeks were not assessed.
How to read the evidence
This is a small prospective study (n=17) without a control group. While the before-after design provides suggestive evidence, the lack of randomization and controls means hormonal changes cannot be definitively attributed to the device versus other factors.
When this study was published
Published in 2016, this study examined the DJBL (EndoBarrier), which has had a complex regulatory history. The device was temporarily withdrawn due to liver abscess concerns but has been investigated in subsequent trials with improved safety monitoring.
The bigger picture
This study illustrates how gut anatomy directly controls appetite peptide signaling. The finding that bypassing a small section of intestine rapidly reprograms hormone responses connects to the broader understanding of why bariatric surgery works so well — and why GLP-1 drugs that mimic some of these hormonal changes are effective for weight loss. It suggests that the location where food contacts the intestine is a critical determinant of which appetite peptides are released.
Questions still open
- Why did ghrelin (typically an appetite-stimulating peptide) increase despite weight loss, and how does this affect long-term appetite?
- Could pharmaceutical agents that mimic the DJBL's hormonal effects replace the device while avoiding its safety risks?
- How do the peptide hormone changes from DJBL compare to those seen with GLP-1 receptor agonists or bariatric surgery?
Common questions
How does bypassing part of the intestine change appetite hormones?
Why did ghrelin increase if the patients were losing weight?
Read the original research
Impact of Duodenal-Jejunal Exclusion on Satiety Hormones.
Obesity surgery, 26(3), 672-8
Citation
de Jonge, Charlotte; Rensen, Sander S; Verdam, Froukje J; Vincent, Royce P; Bloom, Steve R; Buurman, Wim A; le Roux, Carel W; Bouvy, Nicole D; Greve, Jan Willem M. (2016). Impact of Duodenal-Jejunal Exclusion on Satiety Hormones.. Obesity surgery, 26(3), 672-8. https://doi.org/10.1007/s11695-015-1889-y