EDMR is a minimally invasive procedure that recapitulates duodenal mucosa to provide long term insulin eradication and prevent insulin induced hypoglycemic episodes.

1. By: Kartik Sharma
Preet Baxi

2. 2

3. Introduction
EDMR is a minimally invasive procedure that
recapitulates duodenal mucosa.
EDMR aims to
▪ Provide long term insulin eradication
▪ Prevent insulin induced hypoglycemic
episodes
3

4. 4
Novel Revita Catheter

5. METHOD

6. 6
Marking site of interest
Under Ultrasound guidance
Placement of guide wire

7. 7
Placement of catheter at the site of interest Catheter performing Mucosal Ablation

8. 8
Suction of mucosa into
Balloon
Injection of saline
Ablation of lifted mucosal surface

9. Ablated mucosa at the end of the procedure
9

10. Duodenal mucosa after lifting and hydrothermal ablation
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11. Complications
▪ Abdominal Pain(20%)
▪ Duodenal Stenosis(7%)
▪ Minimal-to-mild collagen banding
deposition(1%)
▪ Constipation, Diarrhea, Dyspepsia.
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12. Follow up
▪ Patient is discharged within 24 hr. of
procedure within minimal to no
complications.
▪ Prescribed to have liquid diet for 2
weeks.
▪ Proton Pump inhibitors(PPI)
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13. 13
Lifted duodenal mucosa
After procedure
One month follow up 3 month follow up

14. Nonrandomized Cohort trials
▪ Data reports from 44 patients enrolled in the study who underwent
screening endoscopy in preparation for the EDMR procedure.
▪ A total of 39 treated patients were included in the efficacy analysis.
▪ The average length of duodenal mucosa ablated was 9.3 cm in LS-
DMR and 3.4 cm in SS-DMR.
14
van Baar ACG, Haidry R, Rodriguez Grunert L, Galvao MPN, Bisschops R, Hayee BH, Costamagna G, Deviere J, Bergman JJGHM. Duodenal mucosal resurfacing:
Multicenter experience implementing a minimally invasive endoscopic procedure for treatment of type 2 diabetes mellitus.
Endosc Int Open. 2020 Nov;8(11):E1683-E1689. doi: 10.1055/a-1244-2283. Epub 2020 Oct 22. PMID: 33140025; PMCID: PMC7581486.

15. 15
Result for Oral Glucose tolerance
Pre/Post Procedure
Result for Change in
medications post procedure

16. Sham controlled trials
▪ Eligible candidates participated in 4 week period to confirm stable
baseline glycemia, as well as mediational and nutritional compliance.
▪ Nine region-of-interest (ROIs) were sited in each liver segment
▪ Liver fat fraction (%) recorded for each subject.
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Cherrington, et al. Hydrothermal Duodenal Mucosal Resurfacing Role in the Treatment of Metabolic Disease. Gastrointest Endosc Clin N Am. 2017, 27(2):299-311; 2.
Rajagopalan, et al. 39 (12) 2254-2261; 3. Galvao, et al. Hydrothermal duodenal mucosal resurfacing: a novel procedural therapy for metabolic disease. VideoGIE. 2016,1(1):10–11; 4.
Van Baar et al. Duodenal Mucosal Resurfacing elicits improvements in glycemic and hepatic parameters in
Type 2 Diabetes: complete 1 year results from the first multicenter study.
Digestive Disease Week. Abstract: 2910402, Washington, D.C., 2018.

17. 17
Result for Improvement
in insulin sensitivity
Result for change in
Fasting Plasma Glucose

18. 18
Results for changes in
alanine aminotransferase
Result for changes in Weight/BMI

19. Result
1. Reduced Glycemia (↓HbA1c, ↓FPG )
2. Improved Hepatic indices (↓ALT, ↓AST)
3. Insulin sensitizing (↓HOMA – IR, ↓Lactate Pyruvate Ratio)
4. Improved metabolic parameters (↓Lipids [TAG,FFAs], ↑Antioxidant
capacity)
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20. PROS
• Long term effect
• Prevent risk of insulin induces
hypoglycemia
• Decrease BMI
• Metabolic Homeostasis and
improved liver indices.
• Helps treating Non-Alcoholic
Fatty liver disease(NAFLD).
▪ Limited result if anatomic
deformity present.
▪ Procedure is new and in
Early study.
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CONS

21. Future Plans
▪ Safety and feasibility study new
catheter.
▪ Establishment of durability of effect.
▪ Implementing large scale human trials.
▪ Combination therapy to improve
efficacy (E.g. GLP agonists)
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22. CONCLUSION

23. References
▪ van Baar ACG, Haidry R, Rodriguez Grunert L, Galvao MPN, Bisschops R, Hayee BH, Costamagna G, Deviere J, Bergman JJGHM. Duodenal
mucosal resurfacing: Multicenter experience implementing a minimally invasive endoscopic procedure for treatment of type 2 diabetes
mellitus. Endosc Int Open. 2020 Nov;8(11):E1683-E1689. doi: 10.1055/a-1244-2283. Epub 2020 Oct 22. PMID: 33140025; PMCID:
PMC7581486.
▪ Tomah S, Alkhouri N, Hamdy O. Nonalcoholic fatty liver disease and type 2 diabetes: where do Diabetologists stand? Clin Diabetes
Endocrinol. 2020 Jun 5;6:9. doi: 10.1186/s40842-020-00097-1. PMID: 32518675; PMCID: PMC7275502.
▪ van Baar ACG, Beuers U, Wong K, Haidry R, Costamagna G, Hafedi A, Deviere J, Ghosh SS, Lopez-Talavera JC, Rodriguez L, Galvao Neto MP,
Sanyal A, Bergman JJGHM. Endoscopic duodenal mucosal resurfacing improves glycaemic and hepatic indices in type 2 diabetes: 6-month
multicentre results. JHEP Rep. 2019 Nov 5;1(6):429-437. doi: 10.1016/j.jhepr.2019.10.006. PMID: 32039394; PMCID: PMC7005649.
▪ van Baar ACG, Holleman F, Crenier L, et al Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year
results from the first international, open-label, prospective, multicentre study Gut 2020;69:295-303.
▪ Harith Rajagopalan, Alan D. Cherrington, Christopher C. Thompson, Lee
M. Kaplan, Francesco Rubino, Geltrude Mingrone, Pablo Becerra, Patricia Rodriguez, Paulina Vignolo, Jay Caplan, Leonardo Rodriguez, Mano
el P. Galvao Neto Diabetes Care Dec 2016, 39 (12) 2254-2261; DOI: 10.2337/dc16-0383
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24. ANY QUESTIONS?