Author Interviews, Diabetes, Gastrointestinal Disease / 04.05.2023 Interview with: Celine B. E. Busch, Research Associate Gastroenterology and Hepatology Standard PhD Candidate Dr. Jacques Bergman Professor, Gastroenterology and Hepatology Amsterdam UMC What is the background for this study? Would you describe the ReCET procedure? Response: Currently more than 400 million people worldwide have type 2 diabetes (T2D) and these numbers are rapidly increasing. At the moment there is no treatment option available that effectively treats the root cause of T2D, i.e. insulin resistance, the increasing loss of response to our body’s own insulin. T2D is generally treated with drug therapy, yet drug therapy can be expensive, requires the patient to take their drugs every day, and at best “controls” the disease without actually resolving it. Despite the availability of many T2D drugs, less than 50% of all T2D have adequately controlled blood glucose levels. The duodenum (the first part of the small bowel, immediately distal to the stomach) has proven to play a crucial role in glucose homeostasis in T2D. We know from bariatric surgery, that bypassing the duodenum by an Roux-en-Y Gastric Bypass has an immediate and profound effect on T2D by improving the sensitivity to the body’s own insulin resistance. However, performing invasive bariatric surgery for many T2D is not feasible. But we can reach the duodenum easily via upper GI endoscopy. ReCET is a single endoscopic procedure, performed under deep sedation. The ReCET catheter is advanced next to the scope, and once it is placed in the duodenum the flex circuit is unfolded until it touches the full circumference of the duodenum. The flex circuit contains the electrodes that create a pulsed electric field which “electroporates” the cells. Electroporation irreversibly makes small, that cause the cell to die of natural cell death, or apoptosis. This process can be precisely titrated for its depth of damage and does not generate heat thus avoiding damage to deeper wall layers, a major hurdle for standard endoscopic ablation techniques. The ReCET procedure lasts about 60 minutes to treat a 10-15 cm segment of the duodenum. The procedure does not cause significant side-effects and patients are discharged the same day. (more…)