Introduction: Morbid obesity, which affects over 15 million people, is a major health concern for the United States. Surgical therapy is the most effective means of weight loss. A less costly, truly minimally invasive procedure would be a valuable adjunct in the treatment of morbid obesity.

Methods: The EndoBarrier^TM (GI Dynamics, Inc) duodenal-jejunal bypass sleeve is a totally endoscopic delivered device designed to produce weight loss by altering metabolic pathways and restricting absorption. It is comprised of a selfexpanding nitinol anchor, an impermeable, fluoropolymer sleeve, and two retrieval drawstrings. The coaxial, catheter-based delivery system is introduced into the duodenal bulb over a guide wire and deployed utilizing fluoroscopy. Proximally placed barbs penetrate into the muscularis propria and allow for anchor stabilization within the proximal jejunum. Upon deployment, a bolus of dilute contrast confirms the device is in the correct position. A duodenal-jejunal bypass is created as chyme passes through the inside of the impermeable Endobarrier^TM, while bile and pancreatic enzymes pass outside the sleeve and mix with the chyme at its distal end.

Conclusion: This video describes the first placement and retrieval of a duodenal-jejunal bypass sleeve within the United States. The Endobarrier^TM may offer the morbidly obese population a new totally endoscopic method of weight loss that requires no operative intervention, minimizes cost, and speeds post-procedure recovery. A randomized, single-blind, placebo-controlled, FDA trial evaluating the deployment, efficacy, and removal of the EndoBarrier^TM is underway.