Hybrid Laparoscopic-Endoscopic Partial Jejunal Diversion with Magnetic Anastomosis in Obesity and Type 2 Diabetes: Durable 3-Year Metabolic Results

Background and Aims Most patients with type 2 diabetes have overweight or obesity, yet few undergo bariatric surgery despite its superior metabolic efficacy over medical therapy. Less invasive alternatives are needed. We previously reported 12-month results of partial jejunal diversion (PJD) created using the incisionless magnetic anastomosis system (IMAS). We now report 36-month outcomes. Methods This single-arm, prospective, first-in-human pilot study included 10 patients with obesity, including 4 with type 2 diabetes and 3 with prediabetes. A dual-path jejunal-ileal diversion was created using self-assembling magnets delivered endoscopically through colonoscopes, with laparoscopic port placement in all patients to confirm anastomosis position and assist magnetic coupling where required. After coupling, the magnetic device was expelled spontaneously. Endpoints included weight loss, glycated hemoglobin (HbA1c), and incretin metabolism. Results PJD was successfully created in 10 consecutive patients (60% male; mean baseline BMI 41.1 kg/m²). At 36 months, mean total body weight loss was 15.9% and excess weight loss was 43.2%. Mean HbA1c decreased by 1.8 percentage points in patients with diabetes and by 1.1 percentage points in those with prediabetes. No device-related serious adverse events occurred. Three serious procedure- or anatomy-related adverse events were observed: one trocar injury related to the laparoscopic component, one internal hernia requiring surgical repair, and one elective anastomosis reversal at patient request. Conclusions Endoscopic PJD created using a self-assembling magnetic anastomosis system achieved durable weight loss and glycemic improvement through 36 months, with no device-related serious adverse events.