Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

Abstract

Background Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. Methods A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. Results Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-todecision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. and Other Interventional Techniques Disclaimer This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g. surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g. surgical nurses, dietitians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by healthcare authorities (e.g. regional and national authorities, healthcare institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point Electronic supplementary material The online version of this article (

Angiopoietin-Like Protein 4 Overexpression in Visceral Adipose Tissue from Obese Subjects with Impaired Glucose Metabolism and Relationship with Lipoprotein Lipase

“…For the purposes of this cross-sectional investigation, eighty-eight consecutive male and female obese subjects were recruited among those undergoing pre-intervention metabolic evaluations for bariatric surgery at Sapienza University of Rome, Italy. Patients with body mass index (BMI) ≥ 40 kg/m 2 or BMI: 35–40 kg/m 2 in presence of comorbidities were considered eligible for this study; the inclusion and exclusion criteria followed those reported in the International guidelines for sleeve gastrectomy surgery [ 43 ]. For each eligible subject we collected medical history, and measured routine clinical and experimental parameters on fasting blood samples.…”

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

“…Esophagogastroscopy is considered a routine diagnostic test prior to bariatric surgery and used in detecting asymptomatic benign-like HH and premalignant or malignant lesions. 84 HH contributes to the pathogenesis of GERD, 85 and thus LSG with concomitant hiatal hernia repair (HHR) is seemingly beneficial to patients with GERD. However, an increasing amount of evidence shows that HHR is inefficient in preventing the occurrence and development of GERD after LSG.…”

Cirugía postbariátrica: el último eslabón en el protocolo de cirugía metabólica

“…Los procedimientos restrictivos consisten en la reducción del volumen intragástrico, lo que produce una sensación de saciedad con ingestas pequeñas; algunos ejemplos son la gastroplastia vertical, la banda gástrica ajustable y balones intragástricos. 6 Los procedimientos malabsortivos limitan la cantidad de nutrientes que pasan a la circulación portal al evitar que el alimento pase por un segmento intestinal, el bypass gástrico en Y de Roux es el procedimiento más realizado. 6 La pérdida masiva de peso se define como una reducción ponderal superior al 50% del peso original, que ocasiona alteraciones notorias de la imagen corporal.…”