Endoscopic duodenal ablation for the treatment of type 2 diabetes New insights and techniques

Metabolic disorders such as type 2 diabetes (T2D) are rising worldwide. Largely due to poor diet and lack of exercise. Growing evidence highlights the duodenum, as a key regulator of glucose metabolism. Patients undergoing gastric bypass surgery often show rapid improvement in blood glucose within days, long before significant weight loss occurs. This suggests that bypassing the duodenum itself plays a major role in metabolic benefits. Based on this insight, new therapies have been developed that affect the duodenal mucosa. Since it is easily accessible via upper gastrointestinal endoscopy. One such approach is duodenal mucosal resurfacing (DMR), an endoscopic ablation technique that removes and regenerates the duodenal mucosa. Clinical studies have shown significant improvements in glucose control, with many patients able to discontinue insulin while maintaining stable blood glucose levels. Another technique is recellularization via electroporation therapy (ReCET), that uses electroporation (pulsed electric fields) to induce similar mucosal renewal in the duodenum. Both techniques have demonstrated durable effects without complications. Beyond glucose regulation, duodenal ablation also improves related metabolic conditions, including fatty liver disease, visceral fat accumulation, and cardiovascular risk factors. Additional research is ongoing to better understand the underlying hormonal and cellular mechanisms.
In conclusion, duodenal ablation represents a safe and promising option for the treatment of T2D. Future studies aim to refine these techniques and identify which patient groups will benefit most.