Endoscopically Created Dual-Path Intestinal Diversion Using an Incision-Less Anastomosis System in Obese Subjects: 3-Year Results of Nutrition Observation

Obesity is associated with multiple metabolic disturbances and nutritional risks. Minimally invasive small-intestine interventions are being developed as alternatives to bariatric surgery, aiming to induce weight reduction with a lower risk of malabsorption. This 3-year pilot study evaluated the safety, metabolic effects, and nutritional outcomes of a novel incisionless magnetic anastomosis system (IMAS) creating an endoscopic dual-path intestinal diversion in obese subjects. Ten obese adults (mean BMI 41 kg/m2) underwent endoscopic creation of a jejuno-ileal diversion using the IMAS device. The cohort included subjects with normal glycemia, prediabetes, and type 2 diabetes. Clinical and biochemical parameters were monitored at baseline and at 6-, 12-, 18-, 24-, and 36-month visits. Anthropometry and a full micronutrient profile (vitamins A, E, B1-B12, D, folate, ferritin, albumin, total protein) were assessed. Mean body weight decreased from 120.9±17.8 kg to 101.9±22.2 kg after 36 months (p<0.05), with an excess weight loss of 43.2 %. Serum concentrations of most micronutrients remained within physiological limits; only vitamin B12 and 25(OH)D showed significant declines during long-term follow-up. The procedure was generally well tolerated, with mild gastrointestinal symptoms resolving over time. Endoscopically created dual-path intestinal diversion achieved durable weight reduction over 3 years with a favorable nutritional risk profile. The incidence of micronutrient deficiencies was substantially lower than that reported after malabsorptive bariatric surgery. These results support the potential of this incisionless technique as a less invasive option for obesity management and warrant larger controlled trials.