Does Bypass of the Proximal Small Intestine Impact Food Intake, Preference, and Taste Function in Humans? An Experimental Medicine Study Using the Duodenal-Jejunal Bypass Liner

Madhawi M. Aldhwayan, Werd Al-Najim, Aruchuna Ruban, Michael Alan Glaysher, Brett Johnson, Navpreet Chhina, Georgios K. Dimitriadis, Christina Gabriele Prechtl, Nicholas A. Johnson, James Patrick Byrne, Anthony Peter Goldstone, Julian P. Teare, Carel W. Le Roux, Alexander Dimitri Miras

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The duodenal-jejunal bypass liner (Endobarrier) is an endoscopic treatment for obesity and type 2 diabetes mellitus (T2DM). It creates exclusion of the proximal small intestine similar to that after Roux-en-Y Gastric Bypass (RYGB) surgery. The objective of this study was to employ a reductionist approach to determine whether bypass of the proximal intestine is the component conferring the effects of RYGB on food intake and sweet taste preference using the Endobarrier as a research tool. A nested mechanistic study within a large randomised controlled trial compared the impact of lifestyle modification with vs. without Endobarrier insertion in patients with obesity and T2DM. Forty-seven participants were randomised and assessed at several timepoints using direct and indirect assessments of food intake, food preference and taste function. Patients within the Endobarrier group lost numerically more weight compared to the control group. Using food diaries, our results demonstrated similar reductions of food intake in both groups. There were no significant differences in food preference and sensory, appetitive reward, or consummatory reward domain of sweet taste function between groups or changes within groups. In conclusion, the superior weight loss seen in patients with obesity and T2DM who underwent the Endobarrier insertion was not due to a reduction in energy intake or change in food preferences.
Original languageEnglish
Article number2141
Pages (from-to)2141
Number of pages1
Issue number10
Publication statusPublished (in print/issue) - 20 May 2022

Bibliographical note

Funding Information:
Conflicts of Interest: A.R. received travel fees support from GI Dynamics. A.D.M. has received honoraria for presentations and advisory board contribution by Novo Nordisk, Boehringer Ingelheim, AstraZeneca, Johnson & Johnson and research grant funding from Fractyl. A.P.G. reports funding supported by UK Medical Research Council and Wellcome Trust, outside of the submitted work, was on a Data Safety Monitoring Board for Novo Nordisk, and has received honoraria for presentations and advisory board contribution by Janssen, Pfizer, Novo Nordisk, Zafgen, Soleno Therapeutics Inc, and Millendo Theapeutics Inc, and Merck. C.W.R. is a member of scientific advisory board for Herbalife, GI Dynamics, NovoNordisk, Keyron, Sanofi, has provided ad hoc consulting for Ethicon and Fractyl, occasional speaking engagement for MSD, Boehringer Ingelheim and Lilly. J.P.T. received travel fees support from GI Dynamics. W.A. has received honoraria for presentations and educational grants from Novo Nordisk. The rest of the authors report no conflicts of interest. “The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results”.

Funding Information:
Funding: This study was funded by the Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership reference 12/10/04. C.W.R is funded by the Irish Research Council (IRCLA/2017/234) and The Health Research Board (USIRL-2016-2). A.D.M. has been supported from grants from the JP Moulton Charitable Foundation, National Institute of Health Research, Imperial College Healthcare Charity and Novo Nordisk; N.C. has been supported by grants from Wellcome Trust. The Division of Diabetes, Endocrinology and Metabolism is funded by grants from the UK Medical Research Council (MRC), Biotechnology and Biological Sciences Research Council, and the NIHR; an Integrative Mammalian Biology Capacity Building Award; and an FP7-HEALTH-2009–241592 EuroCHIP grant. It is also supported by the NIHR Biomedical Research Center Funding Scheme. M.A. was funded by the Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.

Funding Information:
Acknowledgments: The devices and nutritional supplements were kindly provided free of charge by GI Dynamics and Nutricia Advanced Medical Nutrition respectively. Infrastructure support was provided by the NIHR Imperial Biomedical Research Center, NIHR Imperial and Clinical Research Facility, London, NIHR Southampton Biomedical Research Center UK and NIHR Southampton clinical research facility, Southampton, UK.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • Endobarrier
  • obesity
  • food preferences
  • eating behaviour
  • taste function
  • Eating
  • Intestine, Small
  • Humans
  • Biomedical Research
  • Obesity/surgery
  • Diabetes Mellitus, Type 2
  • Taste


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