Endoscopic duodenal mucosa ablation techniques for diabetes and nonalcoholic fatty liver disease: A systematic review

Giovanni Musso; Silvia Pinach; Francesca Saba; Franco De Michieli; Maurizio Cassader; Roberto Gambino

doi:10.1016/j.medj.2024.03.014

Endoscopic duodenal mucosa ablation techniques for diabetes and nonalcoholic fatty liver disease: A systematic review

Med. 2024 Mar 27:S2666-6340(24)00126-0. doi: 10.1016/j.medj.2024.03.014. Online ahead of print.

Authors

Giovanni Musso¹, Silvia Pinach², Francesca Saba², Franco De Michieli², Maurizio Cassader², Roberto Gambino²

Affiliations

¹ MECAU San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. Electronic address: giovanni_musso@yahoo.it.
² Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.

PMID: 38579730
DOI: 10.1016/j.medj.2024.03.014

Abstract

Background: Type 2 diabetes mellitus (T2DM) is increasing at an alarming rate, and only 50% of patients with T2DM achieve or maintain adequate glycemic control with pharmacological therapies. Metabolic surgery demonstrated superior efficacy compared to medical therapy but is unfeasible for most patients with T2DM. Duodenal mucosal resurfacing (DMR) by hydrothermal mucosal ablation, recellularization via electroporation therapy (ReCET), and photodynamic therapy are novel endoscopic procedures that use thermal, electrical, and photochemical energy, respectively, to ablate and reset dysfunctional duodenal mucosa. We assessed the data on the effects of these techniques on glycemic control and nonalcoholic fatty liver disease (NAFLD).

Methods: We systematically searched independently and in duplicate English and non-English language publications through January 31st, 2024. Outcomes assessed were an improvement in different metabolic health parameters and the safety of duodenal mucosal ablation (DMA) procedures. Outcomes were presented descriptively.

Findings: We selected 12 reports reporting results from 3 randomized and 6 uncontrolled trials (seven evaluating DMR, two evaluating ReCET, all with a low risk of bias) for a total of 317 patients enrolled. DMA reduced HbA1c, fasting plasma glucose, and liver fat. When combined with newer antidiabetic drugs, it allowed insulin discontinuation in up to 86% patients. No major safety signal emerged.

Conclusions: All DMA techniques improve glucose homeostasis; DMR and ReCET appear to be safe in patients with T2DM. If confirmed by future randomized trials and by trials with histological endpoints in NAFLD, then DMA appears to be a promising alternative or complement option to medications for T2DM and NAFLD treatment.

Funding: This study received no funding.

Keywords: DMR; Foundational research; PDT; ReCET; ReVita; duodenal mucosa dysfunction; duodenal mucosal resurfacing; photodynamic therapy; recellularization via electroporation therapy.