AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, THE OBESITY SOCIETY, AND AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE PERIOPERATIVE NUTRITIONAL, METABOLIC, AND NONSURGICAL SUPPORT OF THE BARIATRIC SURGERY PATIENT

Abstract

American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health‐care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.

Encefalopatía de Wernicke y polineuropatía asociada a déficit de complejo B después de una cirugía bariátrica

“…La mayoría de estos factores deberían ser buscados activamente en el estado prequirúrgico. (7,8,9,17,25).…”

“…Es de suma importancia que el suplemento de tiamina se administre antes que cualquier suplemento con glucosa, ya que, como se dijo anteriormente, de no ser así se puede empeorar el pronóstico (3,9,12,14,17,19,21,22,27,29).…”

“…Se recomienda, en pacientes después de cirugía bariátrica con síntomas neurológicos sugestivos de una deficiencia de tiamina (encefalopatía de Wernicke o polineuropatía), iniciar un tratamiento intravenoso agresivo con tiamina (mínimo 100 mg/ día) por 7 a 14 días (1,3,4,6,7,9,19,24,25,27,29).…”

“…Aunque es un hecho que no ocurre una malabsorción de calorías, el efecto de pérdida de peso no se correlaciona con la reducción del volumen gástrico, sino con alteraciones centrales y con reducción en la ingestión, lo que produce una pérdida de peso de forma gradual y duradera (4,5,8,9).…”

Overview of Emerging Concepts in Metabolic Surgery

“…(Tables 1 and 2). 6,7 The most recent guidelines of the American Diabetes Association 8 state that "bariatric surgery should be considered for adults with BMI >35 kg/m 2 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle modification and pharmacologic therapy." Surgical candidates must have tried other weight-loss modalities (diet, exercise, etc) before consideration of bariatric surgery.…”