Angelica Bottaro is a writer with expertise in many facets of health including chronic disease, Lyme disease, nutrition as medicine, and supplementation.
Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases.
Duodenal mucosal resurfacing (DMR) is a minimally invasive procedure that uses heat to resurface the upper intestine. Like bariatric surgery (weight-loss surgery), it has been shown to help with diabetes, but it’s less risky than bariatric surgery.
Learn more about the pros and cons of this procedure and whether it would be appropriate for you.
Ridofranz / Getty Images
DMR is done for people with diabetes to help them better manage the disease. It is a surgery that involves using heat to resurface the upper intestinal lining. The surgery helps regenerate (regrow and replace) the lining of the upper intestine, which improves how nutrients are absorbed from the duodenum, the upper part of the intestine that connects the small intestine to the stomach.
Research has shown that when the duodenum does not function properly, it can lead to insulin resistance, hyperinsulinemia (too much insulin in the blood), and the body’s impaired ability to process, break down, and use glucose properly.
While having a damaged duodenum isn’t considered a direct cause of diabetes, one study found that it can play a role in the disease. It is possible that correcting it can significantly improve blood sugar management.
DMR surgery can improve the body’s response to insulin (a hormone created by your pancreas that controls the amount of glucose, or sugar, in your bloodstream) by correcting how the intestines absorb nutrients and other chemicals. According to research, having just one DMR procedure can help people with diabetes replace their insulin therapy with oral medication that improves how the body uses insulin.
While the reason for the improvement isn’t entirely known, it’s thought that DMR helps regulate the body’s bile acid response. Bile acid play a role in diabetes because of its ability to stimulate insulin secretion as well as glucagon-like peptide 1, which is an intestinal hormone that helps with blood sugar regulation. By improving bile acid response, changes occur within the body that enhance how insulin is used. This improves how much sugar is converted into energy for cells and how much stays in the blood.
DMRs are typically performed for people who take diabetes medications but these drugs don't work as they should. People with diabetes taking insulin can also have a DMR if they want to manage their diabetes using oral medication instead. As it stands, DMRs cannot replace diabetes therapy, including taking insulin, completely.
The minimally invasive surgical procedure is done using an endoscope. An endoscope is a long and thin tube with a camera on the end of it. During the procedure, the endoscope is inserted into the body through the mouth to reach the duodenum.
A catheter with a heated balloon attached to the end is inserted through the mouth and down to the top of the small intestine. The heat from the balloon on the catheter changes cells in the duodenum so that they are better able to absorb glucose and release the hormones needed to control blood sugar levels.
Since a DMR may be uncomfortable, people undergoing the procedure are either sedated or under anesthesia throughout the entire process. After you are done, you will be required to spend one night in the hospital for monitoring.
While DMRs are considered both safe and effective, they may cause some side effects. Some mild and common side effects are:
Extremely rare adverse events have also occurred following a DMR procedure, including:
While the exact incidence of rare adverse events is unknown, in one study, only one person experienced rectal bleeding following their DMR, and only one incidence of perforation occurred.
According to research, the outlook following a DMR for people with diabetes is good. One double-blind study (a study in which neither the researchers or subjects know if they are being given the therapy being studied or a placebo) examined the effectiveness of the procedure 24 weeks after it was performed. It found that every person who underwent a DMR was able to manage their diabetes effectively with medication. It also improved insulin resistance.
The risks of a DMR are minimal, and the procedure is considered highly safe and effective. However, all surgical procedures may come with some risks. For example, severe adverse events have been documented, such as perforation and rectal bleeding. As with any type of upper GI endoscopy procedure, risks other than the ones mentioned above may occur, such as bleeding or infection.
Some complications may also occur because of general anesthetic, including:
There is no documentation surrounding a DMR causing death. However, anesthesia can, in rare cases, cause mortality. In the United States, roughly 1.1 people per 1 million will die from surgical anesthesia each year.
Bariatric surgery is another treatment option used to help treat diabetes. It is typically reserved for people with diabetes who also have obesity. It helps with weight loss, and people with obesity may be able to manage their disease better if they are at a lower weight.
While the surgery has been shown to improve blood sugar control in many people, it is far more invasive than a DMR and comes with more risks, such as:
Regarding a surgical option for diabetes management, both bariatric surgery and DMRs have pros and cons. The surgery that’s best for you is the one you’re most comfortable with after speaking to your healthcare provider.
DMRs are minimally invasive surgical procedures that can help people with diabetes control their blood sugar levels. DMR works by restoring the action of bile acid and the duodenum, improving the body’s ability to absorb nutrients and chemicals that help better manage diabetes. As with any surgery, there are some side effects and risks associated with DMRs.
You can be doing all the right things and still have trouble with your blood sugar levels. Diabetes is complex, and even the right actions are not always enough. The good news is that more options for treating type 2 diabetes, such as DMRs, are emerging. While a surgical procedure is never exciting, it can give you hope for better disease management now and in the future.
Duodenal mucosal resurfacing is minimally invasive, but it is still a surgical procedure. Because of that, you will likely have to stay in the hospital overnight for monitoring. During that time, your medical support staff will ensure that no complications arise and that you are well taken care of after the surgery.
According to research surrounding the procedure, there are minimal risks attached to it. DMRs are considered safe for many individuals, with few severe adverse effects reported. The most common side effects are mild and not cause for concern.
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Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.
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