The eighth edition of IMAGE (International Meeting for Advanced Gastroenterology Endoscopy), the international course in endoscopy that brought together specialists from 31 countries in Humanitas, ended on 17 June.

Among the novelties presented, a phase II clinical trial to validate the efficacy of the first endoscopic procedure that uses heat to treat type 2 diabetes.

Professor Alessandro Repici, Head of Digestive Endoscopy at Humanitas and among IMAGE directors, spoke about this in an interview with Cuore e denari on Radio24.


The spread of diabetes

“Endoscopy is the non-invasive technique that allows access to our body, particularly the digestive system, through a flexible tube (endoscope) using natural orifices (rectum and mouth).

During IMAGE we presented the preliminary results of the study that concerns the population of patients with type 2 diabetes (in Italy alone there are more than 3 million). Diabetes is very widespread throughout the world and its presence is associated with complications that are also important: poor blood glucose control, for example, can affect the cardiovascular system and kidney function,” explains Prof. Repici.


The new endoscopic technique

“The technique we are developing and testing in a circuit of eight hospitals in Europe, involves a kind of rejuvenation of the duodenal mucosa.

The duodenum, the final part of the stomach, regulates the secretion of hormones in our metabolism. Patients who develop diabetes tend to have a different differentiation of the cells of this tract; cells in fact age and are no longer as skilled as before in responding to the introduction of food. When we eat we introduce calories and our body needs to understand how to use them and where to store the excess. Type 2 diabetes profoundly alters these regulatory mechanisms.

The duodenum is easily accessible with the endoscope: using thermoablation and therefore heat, we remove the superficial part of the cells, or the malfunctioning part, thus allowing the younger cells that are deep down to climb up and produce hormones and regulate metabolism. It is as if the duodenal mucosa is very rejuvenated, a necessary operation because the lack of control of metabolism is precisely linked to the fact that the cells present in the duodenum can no longer do their job,” Professor Repici explains.


Advantages for patients

“In the results of the initial phase of the study, this technique was combined with very effective blood glucose control over a prolonged period. However, we do not yet have the definitive results, but it is worth pointing out that if the study ultimately shows that blood glucose control is not permanent but only lasts for a few years, we would still have an advantage for patients who would not be linked to taking medication, with a positive impact on quality of life.

Effective immediate control is also associated with a huge long-term benefit in relation to diabetes complications,” concluded Professor Repici.