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Gastrointest Endosc Clin N Am. 2017 Apr;27(2):299-311. doi: 10.1016/j.giec.2016.12.002.

Hydrothermal Duodenal Mucosal Resurfacing: Role in the Treatment of Metabolic Disease.

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Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, 704A/710 Robinson Research Building, 2200 Pierce Avenue, Nashville, TN 37232-0615, USA. Electronic address:
Fractyl Laboratories, Inc, 17 Hartwell Avenue, Lexington, MA 02421, USA.
Medical-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels 1070, Belgium.


The duodenum has become recognized as a metabolic signaling center that is involved in regulating insulin action and, therefore, insulin resistance states such as type 2 diabetes. Bariatric surgery and other manipulations of the upper intestine, in particular the duodenum, have shown that limiting nutrient exposure or contact in this key region exerts powerful metabolic effects. Early human clinical trial data suggest that endoscopic hydrothermal duodenal mucosal resurfacing is well tolerated in human subjects and has an acceptable safety profile. This article describes the rationale for this endoscopic approach and its early human use, including safety, tolerability, and early efficacy.


Duodenal mucosal resurfacing; Duodenum; Endoscopic treatment; Hydrothermal ablation; Insulin resistance; Metabolic disease; Nonalcoholic fatty liver disease; Type 2 diabetes

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