EndoBarrier: A Tube in the Intestine for Successful Weight Loss | Specialists & Clinics for General and Visceral Surgery

After eating, chewed food enters the stomach, where it is broken down into a pulp. This food pulp is then released in small amounts into the small intestine. This is where digestion actually takes place. Enzymes break down the food, and the nutrients are absorbed into the bloodstream through the intestinal wall.

An EndoBarrier acts as an artificial barrier in this process. It lines the upper part of the small intestine from the inside, thereby preventing contact between the intestinal wall and the food pulp. As a result, the body can absorb nutrients only to a limited extent.

An EndoBarrier is a thin, flexible tube approximately 60 cm long. During a minimally invasive procedure, the surgeon implants the tube into the upper part of the small intestine and secures it in place.

The artificial barrier effectively blocks nutrient absorption by the intestinal villi along the entire length of the tube. An EndoBarrier is therefore also suitable for weight loss in severely obese patients, as it leads to a significant reduction in calorie intake. 

Due to the altered passage of food, the body responds by releasing increased amounts of hormones that positively influence metabolism and promote a feeling of fullness. Clinical studies show that bariatric surgeons can achieve an average weight loss of approximately 20 percent using this method.

The EndoBarrier is inserted into the upper portion of the small intestine © bilderzwerg | AdobeStock

The EndoBarrier specifically influences the digestive process by controlling the movement of food through the duodenum. By lining the inside of the intestine with a special artificial membrane, it prevents nutrients from coming into direct contact with the intestinal wall. This not only reduces calorie intake but also regulates the release of hormones that play a crucial role in the development of obesity and diabetes.

At the same time, it triggers the release of hormones that act as a kind of positive counterbalance, regulating overall fat metabolism and promoting a feeling of fullness. This allows body weight to stabilize over the long term, while blood sugar levels improve. 

The benefits of EndoBarrier therapy are:

• a short, minimally invasive procedure without large incisions,
• low risk and a quick recovery time,
• high effectiveness with proven weight loss of up to 20 percent,
• significant regulation of blood sugar in type 2 diabetes.

Typically, an EndoBarrier is implanted during a routine gastroscopy by a specialist under brief anesthesia.

The gastroscopy is performed using a thin tube equipped with a light source and a camera; it is a minimally invasive procedure for examining the esophagus and intestines directly from the inside.

The doctor inserts this tube through the mouth and down the esophagus into the stomach. The camera transmits live images directly to a monitor, allowing the doctor to examine the inner walls of the organs in detail.

During the gastroscopy, the doctor can also insert the EndoBarrier into the planned location in the duodenum. A medical X-ray probe is used to verify the correct positioning of the EndoBarrier while the procedure is still in progress.

Surgery involving incisions and resulting scars is not necessary for EndoBarrier implantation. This technologically advanced method is ultimately a simple yet highly effective endoscopic procedure.

Is the specific implantation procedure through the stomach painful?

You will be given general anesthesia before the procedure begins. As a result, you will not be aware of the gastroscopy or the placement of the EndoBarrier in the intestinal tract.

Any brief discomfort immediately following the minor procedure passes quickly.

For people suffering from severe obesity and diabetes mellitus (with a BMI of 30–45), EndoBarrier can deliver convincing results. EndoBarrier is also an alternative to invasive bariatric surgery for obesity.

In the summer of 2012, the EndoBarrier method was used for the first time on an obese patient.

However, pregnant women are not eligible for EndoBarrier treatment.

Eating Habits, Daily Activities, and Exercise

After EndoBarrier implantation, patients may need to adjust their eating habits and daily activities. Before the procedure, your doctor will carefully explain what you need to be aware of after surgery.

You may need to adjust to eating different foods and changing your portion sizes. However, a varied and healthy, light diet is always permitted. Unlike before, you’ll feel full much more quickly after eating, and that feeling of fullness will last longer. It’s recommended that you drink as little alcohol as possible. 

Immediately after the implant is inserted, you must not drive a car or perform physically strenuous activities. Normally, you can quickly resume your daily activities after the procedure.

Exercise is actually strongly recommended with an EndoBarrier. This helps you stay fit and prevents weight regain. If necessary, ask a sports medicine doctor for more information.

Taking Medications with an EndoBarrier

You may need to adjust your medication regimen. You must not take the following classes of medications while using an EndoBarrier:

• NSAIDs: anti-inflammatory drugs such as ibuprofen, aspirin, or naproxen,
• all anticoagulants such as warfarin and heparin.

Your treating physician will prescribe alternative medications with less disruptive active ingredients if necessary.

Patients with type 2 diabetes must follow additional guidelines. The treatment significantly improves insulin levels and, consequently, blood sugar levels. After the device is inserted, you should therefore consult your endocrinologist promptly to adjust your insulin therapy.

In most cases, a reduction in the insulin dose is necessary. Otherwise, hypoglycemia (dangerously low blood sugar) may occur.

The most common side effects after implantation are:

• Abdominal pain
• Nausea or vomiting
• Fatigue
• Dizziness
• Confusion
• Rarely: Post-operative bleeding or blood in the stool
• possibly fever and chills.

The high success rate of the EndoBarrier procedure has been sufficiently proven scientifically.

However, most health insurance plans generally do not cover the cost of the procedure. This means that you will likely have to pay for the treatment yourself. The implantation typically costs up to 6,100 €. After 12 months, the membrane must be removed, which costs an additional 1,600 €. The doctor generally monitors and oversees the weight loss process. 

The procedure is worth it; patients with an EndoBarrier often benefit from the following results: 

• Noticeable weight loss as early as two weeks after implantation.
• Blood sugar levels normalize in patients with type 2 diabetes mellitus in the following months.
• Optimization of HbA1c levels (as demonstrated by the relevant diabetes blood test) indirectly leads to clinically significant weight loss.

An EndoBarrier is a flexible tube approximately 60 cm long that is placed in the upper portion of the small intestine via gastroscopy. The thin membrane prevents the food bolus from coming into contact with the intestinal wall, thereby blocking nutrient absorption. This results in an earlier feeling of fullness and weight loss. A positive side effect is the stabilization of blood sugar levels in type II diabetes. 

Typically, the artificial barrier remains in the body for about 12 months and is then removed. Both insertion and removal can be performed endoscopically and do not require surgery. 

The procedure is generally considered low-risk, though in rare cases, nausea, vomiting, or minor bleeding may occur. For patients with type II diabetes mellitus, there is a risk of hypoglycemia due to reduced nutrient absorption. Medication should be adjusted accordingly afterward. 

No, health insurance plans do not normally cover the procedure. You will be responsible for the costs of both insertion (approx. €6,100) and removal (approx. €1,600). Many clinics offer customized payment plans.