Episode 43: The one where I discuss all things Fractyl with Dr. Harith Rajagopalan
The Interventional Endoscopist · Mar 12, 2026 · 1:04:12
The Interventional Endoscopist
The Interventional Endoscopist · Mar 12, 2026 · 1:04:12
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Resetting the Metabolic Setpoint: Duodenal Mucosal Resurfacing (DMR) and the Future of Obesity Care with Dr. Harith Rajagopalan
Is the duodenum the "early warning beacon" for metabolic disease? In this episode, we sit down with Dr. Harith Rajagopalan, MD, PhD, Co-Founder and CEO of Fractyl Health, to discuss the revolutionary shift from treating downstream symptoms of diabetes and obesity to addressing the upstream root cause in the gut.
We dive deep into the science and technique of Duodenal Mucosal Resurfacing (DMR)—an automated, 45-minute endoscopic outpatient procedure designed to reset the metabolic setpoint. Dr. Rajagopalan explains how high-fat, high-sugar diets pathologically alter the duodenal mucosa and how "resurfacing" this tissue can provide a durable off-ramp for patients on GLP-1 therapies.
Key highlights include:
The "Reset" Mechanism: How the duodenum acts as the body's nutrient-sensing center and why it becomes dysfunctional.
Technical Deep Dive: A look at the automated circumferential saline injection and thermal ablation process (and the future of through-the-scope devices).
The "Remain" Trial Data: Breakthrough insights into post-GLP-1 weight maintenance and craving reduction.
The Rejuva Platform: A look at the first-in-class EUS-guided gene therapy targeting the pancreas.
Whether you are a fellow learning the ropes or an attending looking for the next frontier in interventional GI, this episode explores a future where endoscopists own the management of metabolic disease.
Episodes: The Interventional Endoscopist
