Prospective study of a new endoscopic duodenal–jejunal bypass sleeve in obese patients with nonalcoholic fatty liver disease (with video)
Abstract
Objectives: To evaluate the safety and efficacy of a new endoscopic duodenal–jejunal bypass sleeve (DJBS) in obese patients with nonalcoholic fatty liver disease (NAFLD), while in situ for 3 months, and at 6 months postexplantation. Methods: Patients with obesity and NAFLD were enrolled in this single‐center, prospective study, wherein the TONGEE DJBS (Tangji Medical, Hangzhou, China) was implanted for 3 months. Primary outcomes were weight loss and changes in hepatic steatosis. Secondary outcomes included changes in liver enzymes, glycemic control, and lipid profile and device safety. Results: Twenty‐six patients (age 35.2 ± 7.2 years; 61.5% women) underwent DJBS implantation. At 3 months, bodyweight change from baseline was −8.0 ± 3.6 kg (P < 0.001), corresponding to 8.9 ± 4.0% of total bodyweight. Hepatic steatosis significantly improved based on controlled attenuation parameter, hepatic steatosis index, and fatty liver index (P < 0.001). Liver enzymes, insulin resistance, and metabolic parameters were also improved. At 6 months postexplantation, weight loss and improvements in hepatic steatosis and liver enzyme levels remained statistically significant. Only one patient had a serious adverse event, namely, upper gastrointestinal hemorrhage. Conclusions: Three‐month TONGEE DJBS implantation resulted in significant weight loss and improvement in hepatic steatosis, liver enzymes, insulin resistance, and metabolic parameters in obese patients with NAFLD. Randomized controlled trials are required to further elucidate these initial findings.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The TONGEE DJBS device yields 8.9% total weight loss in three months.
“A Chinese study on the TONGEE DJBS device reported an 8.9% TWL in three months, with over 50% of patients maintaining > 5% TWL six months post-removal [100].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [100]
Over 50% of patients maintain >5% total weight loss six months post-removal after TONGEE DJBS.
“A Chinese study on the TONGEE DJBS device reported an 8.9% TWL in three months, with over 50% of patients maintaining > 5% TWL six months post-removal [100].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [100]
EndoBarrier reduces HSI by five points at 9 months.
“Hepatic steatosis index (HSI): EndoBarrier reduced HSI by five points at 9 months (p < 0.001) [100], POSE by 11.16 points (p < 0.002) [88], and ESG by 4–4.85 points at one year [82,85].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [100]
Cites
Younossi, Z. M., Koenig, A. B., Abdelatif, D., Fazel, Y., Henry, L., & Wymer, M. (2016) · Hepatology · doi:10.1002/hep.28431 · Cited by 10,781 · see citing works
Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., & Tiribelli, C. (2006) · BMC Gastroenterology · doi:10.1186/1471-230x-6-33 · Cited by 3,054 · see citing works
Non-alcoholic fatty liver disease
Powell, E. E., Wong, V. W.-S., & Rinella, M. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32511-3 · Cited by 2,789 · see citing works
Estes, C., Razavi, H. A., Loomba, R. S., Younossi, Z. M., & Sanyal, A. J. (2017) · Hepatology · doi:10.1002/hep.29466 · Cited by 2,416 · see citing works
Eddowes, P. J., Sasso, M., Allison, M., Tsochatzis, E. A., Anstee, Q. M., Sheridan, D. A., Guha, I. N., Cobbold, J., Deeks, J. J., Paradis, V., et al. (2019) · Gastroenterology · doi:10.1053/j.gastro.2019.01.042 · Cited by 1,425 · see citing works
Karlas, T., Petroff, D., Sasso, M., Fan, J.-G., Mi, Y.-Q., de Lédinghen, V., Kumar, M., Lupsor-Platon, M., Han, K.-H., Cardoso, A. C., et al. (2017) · Journal of Hepatology · doi:10.1016/j.jhep.2016.12.022 · Cited by 1,275 · see citing works
Lassailly, G., Caiazzo, R., Ntandja-Wandji, L.-C., Gnemmi, V., Baud, G., Verkindt, H., Ningarhari, M., Louvet, A., Leteurtre, E., Raverdy, V., et al. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.06.006 · Cited by 622 · see citing works
Targher, G., Tilg, H., & Byrne, C. D. (2021) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(21)00020-0 · Cited by 586 · see citing works
Younossi, Z. M., Corey, K. E., & Lim, J. K. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.11.051 · Cited by 503 · see citing works
A pathway to endoscopic bariatric therapies
(2011) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2011.09.008 · Cited by 152 · see citing works
Jirapinyo, P., Haas, A. V., & Thompson, C. C. (2018) · Diabetes Care · doi:10.2337/dc17-1985 · Cited by 134 · see citing works
Meffert, P. J., Baumeister, S. E., Lerch, M. M., Mayerle, J. V., Kratzer, W., & Völzke, H. (2014) · The American Journal of Gastroenterology · doi:10.1038/ajg.2014.155 · Cited by 128 · see citing works
A pathway to endoscopic bariatric therapies
Ginsberg, G. G., Chand, B., Coté, G. A., Dallal, R. M., Edmundowicz, S. A., Nguyen, N. T., Pryor, A. D., & Thompson, C. C. (2011) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2011.08.053 · Cited by 124 · see citing works
Escalona, A., Pimentel, F., Sharp, A. C., Becerra, P., M, M. S., Turiel, D., Muñoz, R., Claudia Bambs, S., Guzmán, S., Ibañez, L. A., et al. (2012) · Annals of Surgery · doi:10.1097/sla.0b013e31825498c4 · Cited by 112 · see citing works
Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost‐effectiveness analysis
Klebanoff, M. J., Corey, K. E., Chhatwal, J., Kaplan, L. M., Chung, R. T., & Hur, C. (2016) · Hepatology · doi:10.1002/hep.28958 · Cited by 91 · see citing works
Adverse Events of the Duodenal-Jejunal Bypass Liner: a Systematic Review
Betzel, B., Drenth, J. P. H., & Siersema, P. D. (2018) · Obesity Surgery · doi:10.1007/s11695-018-3441-3 · Cited by 53 · see citing works
de Jonge, C., Rensen, S. S., Koek, G. H., Joosten, M. F., Buurman, W. A., Bouvy, N. D., & Greve, J. W. M. (2013) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2013.07.029 · Cited by 43 · see citing works
Eilenberg, M., Munda, P., Stift, J., Langer, F. B., Prager, G., Trauner, M., & Staufer, K. (2021) · HepatoBiliary Surgery and Nutrition · doi:10.21037/hbsn-20-787 · Cited by 42 · see citing works
Gollisch, K., Lindhorst, A., & Raddatz, D. (2016) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/s-0042-118961 · Cited by 42 · see citing works
Upper Limits of Normal for Serum Alanine Aminotransferase Levels in Chinese Han Population
Zheng, M., Shi, K., Fan, Y., Liu, W., Lin, X., Li, L., & Chen, Y. (2012) · PLoS ONE · doi:10.1371/journal.pone.0043736 · Cited by 34 · see citing works
Tavaglione, F., Vincentis, A. D., Bruni, V., Gallo, I. F., Carotti, S., Tuccinardi, D., Spagnolo, G., Ciociola, E., Mancina, R. M., Jamialahmadi, O., et al. (2021) · Liver International · doi:10.1111/liv.15127 · Cited by 32 · see citing works
Changes in glycemic control and body weight after explantation of the duodenal-jejunal bypass liner
Betzel, B., Koehestanie, P., Homan, J., Aarts, E. O., Janssen, I. M. C., de Boer, H., Wahab, P. J., Groenen, M. J. M., & Berends, F. J. (2016) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2016.07.027 · Cited by 23 · see citing works
Jung, S. H., Yoon, J. H., Choi, H. S., Nam, S., Kim, K. O., Kim, D. H., Kim, J., Sohn, W., Hyun, Y. S., Park, C. H., et al. (2020) · Endoscopy · doi:10.1055/a-1149-1862 · Cited by 21 · see citing works
Ruban, A., Miras, A. D., Glaysher, M. A., Goldstone, A. P., Prechtl, C. G., Johnson, N. A., Chhina, N., Al‐Najim, W., Aldhwayan, M., Klimowska‐Nassar, N., et al. (2022) · PubMed Central · doi:10.1097/sla.0000000000004980 · Cited by 20 · see citing works
Endoscopic bariatric therapies for obesity: a review
Staudenmann, D., Sui, Z., Saxena, P., Kaffes, A. J., Marinos, G., Kumbhari, V., Aepli, P. R., & Sartoretto, A. (2021) · The Medical Journal of Australia · doi:10.5694/mja2.51179 · Cited by 16 · see citing works
Flagged first, then by citations
1 of the 26 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Fatty liver index (FLI): more than a marker of hepatic steatosis
Kaneva, A. M., & Bojko, E. R. (2023) · Journal of Physiology and Biochemistry · doi:10.1007/s13105-023-00991-z · Cited by 60 · see citing works
Tasabehji, D., Saleh, S., & Mokadem, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14124012 · Cited by 14 · see citing works
Chen, W., Feng, J., Dong, S., Guo, J., Zhou, F., Hu, S., Hu, R., Wang, C., Ma, Y., & Dong, Z. (2024) · Obesity Reviews · doi:10.1111/obr.13812 · Cited by 8 · see citing works
Ren, M., Yi, X., Pan, H., Zhou, X., Yu, M., & Ji, F. (2025) · Hepatology Communications · doi:10.1097/hc9.0000000000000615 · Cited by 6 · see citing works
Self-citationBoškoski, I., Matteo, M. V., Shamah, S., Dayyeh, B. K. A., Bove, V., Siena, M. D., Huberty, V., Maselli, R., Perretta, S., Pontecorvi, V., et al. (2025) · Endoscopy · doi:10.1055/a-2630-2062 · Cited by 6 · see citing works
Ren, M., Pan, H., Zhou, X., Yu, M., & Ji, F. (2024) · Scientific Reports · doi:10.1038/s41598-024-59605-3 · Cited by 6 · see citing works
Self-citationLahooti, A., Johnson, K. E., & Sharaiha, R. Z. (2024) · Gastrointestinal Endoscopy Clinics of North America · doi:10.1016/j.giec.2024.07.001 · Cited by 6 · see citing works
Recent advances in clinical practice endohepatology: the endoscopic liver rush
Vanderschueren, E., Praktiknjo, M., Wiest, R., Cárdenas, A., Trebicka, J., & Laleman, W. (2025) · Gut · doi:10.1136/gutjnl-2025-334725 · Cited by 5 · see citing works
Güldan, M., Özbek, L., Abdel‐Rahman, S. M., Narin, A. E., Orak, H. İ., Goren, H. K., Afşar, B., Rossing, P. R., & Kanbay, M. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70019 · Cited by 5 · see citing works
Small intestine‐targeted endoscopic bariatrics: Current status and future perspectives
Ren, M., & Ji, F. (2023) · Digestive Endoscopy · doi:10.1111/den.14575 · Cited by 5 · see citing works
Self-citationHow far are we from an approved drug for nonalcoholic steatohepatitis?
Méndez‐Sánchez, N., Pal, S. C., & Córdova‐Gallardo, J. (2023) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2023.2206953 · Cited by 3 · see citing works
Endobariatric systems: Strategic integration of endoscopic therapies in the management of obesity
Nassani, N., Bazerbachi, F., & Dayyeh, B. K. A. (2024) · Indian Journal of Gastroenterology · doi:10.1007/s12664-024-01632-z · Cited by 3 · see citing works
Cost-effectiveness analysis of duodenal–jejunal bypass sleeve device for people with obesity
Xu, Q., Yan, W., Li, L., & Liu, B. (2025) · Health Economics Review · doi:10.1186/s13561-025-00623-w · Cited by 2 · see citing works
Small Bowel Therapies for Metabolic Disease and Obesity
Boškoski, I., Gualtieri, L., & Matteo, M. V. (2024) · Gastrointestinal Endoscopy Clinics of North America · doi:10.1016/j.giec.2024.06.002 · Cited by 1 · see citing works
Zhang, L., Zhou, B., Li, Z., & Meng, H. (2024) · Asian Journal of Surgery · doi:10.1016/j.asjsur.2024.02.082 · Cited by 1 · see citing works
Jin, T., Zhou, Y., Sun, P., Ding, L., Xu, L., Ji, F., & Jin, X. (2025) · Scientia Sinica Vitae · doi:10.1360/ssv-2025-0009
Self-citationEnteroscopy-guided retrieval of a migrated gastric bypass stent from the mid-to-distal jejunum
Chen, S., Li, W., & Duan, T. (2025) · Endoscopy · doi:10.1055/a-2712-3652
- Authors
- Ren, M., Zhou, X., Yu, M., Cao, Y., Xu, C., Yu, C., & Ji, F.
- Affiliations
- First Affiliated Hospital Zhejiang University (CN)
- Corresponding author
- Ji, Feng
- Venue
- Digestive Endoscopy
- Publisher
- Wiley
- Published
- 2022-08-23
- Volume
- 35
- Issue
- 1
- Pages
- 58-66
- ISSN
- 0915-5635 (ISSN-L)
- 1443-1661
- OpenAlex
- W4286697206
- Cited by
- 17
- References
- 26
- Citations by year
- 2025: 8 · 2024: 6 · 2023: 3
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Digestive Endoscopy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Key Research and Development Program of Zhejiang Province (2019C03031)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- non-alcoholic fatty liver disease, obesity, weight loss, hepatic steatosis, liver enzymes, insulin resistance, glycemic control, lipid profile, device safety, upper gastrointestinal bleeding
- MeSH terms
- Adult, Female, Humans, Insulin Resistance, Liver, Male, Obesity, Prospective Studies, Weight Loss, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
