Endoscopic duodenal mucosal resurfacing: A potential treatment for metabolic diseases

Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure for the treatment of metabolic diseases characterised by peripheric insulin resistance. DMR consists of circumferential hydrothermal ablation of the altered duodenal mucosa, which plays a driving role in the pathogenesis of type 2 diabetes (T2D) and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/ NASH). Data from multicentre single-arm studies and a randomised-controlled trial have shown promising results for the treatment of non-insulin-dependent T2D, particularly for more severe glycaemic decompensation. A meta-analysis has shown a significant reduction of mean Hb1Ac levels of 1.72% and 0.94% at 3 and 6 months, respectively. Some data suggest a beneficial effect of DMR for NAFLD/NASH, though no proven evidence of resolution is currently available. DMR is associated with a favourable safety profile, as most adverse events are mild and temporary. Further research is necessary to better define the therapeutic role of DMR and the criteria for proper patient selection.