Kamal K Mahawar1,2, Islam Omar3, Rishi Singhal4, Sandeep Aggarwal5, Mustafa Ismail Allouch6, Salman K Alsabah7, Luigi Angrisani8, Faruq Mohamed Badiuddin9, Jose María Balibrea10, Ahmad Bashir11, Estuardo Behrens12, Kiron Bhatia13, Laurent Biertho14, L Ulas Biter15, Jerome Dargent16, Maurizio De Luca17, Eric DeMaria18, Mohamed Hayssam Elfawal19, Martin Fried20, Khaled A Gawdat21, Yitka Graham3,22, Miguel F Herrera23, Jacques M Himpens24, Farah A Hussain25, Kazunori Kasama26, David Kerrigan27, Lilian Kow28, Jon Kristinsson29, Marina Kurian30, Ronald Liem31, Rami Edward Lutfi32, Vinod Menon33, Karl Miller34, Patrick Noel35,36, Oral Ospanov37, Mahir M Ozmen38, Ralph Peterli39, Jaime Ponce40, Gerhard Prager41, Arun Prasad42, P Praveen Raj43, Nelson R Rodriguez44, Raul Rosenthal45, Nasser Sakran46, Jorge Nunes Santos47, Asim Shabbir48, Scott A Shikora49, Peter K Small3,22, Craig J Taylor50, Cunchuan Wang51, Rudolf Alfred Weiner52, Mariusz Wylezol53, Wah Yang51, Ali Aminian54. 1. Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK. kmahawar@gmail.com. 2. Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK. kmahawar@gmail.com. 3. Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK. 4. Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK. 5. All India Institute of Medical Sciences (AIIMS), New Delhi, India. 6. Nini Hospital, Tripoli, Lebanon. 7. Kuwait University, Kuwait, Kuwait. 8. University of Naples, Naples, Italy. 9. Valiant Clinic, Dubayy, United Arab Emirates. 10. Hospital Clínic de Barcelona, Barcelona, Spain. 11. GBMC at Jordan Hospital, Amman, Jordan. 12. New Life Center, Guatemala, Guatemala. 13. Austin Health, Melbourne, Australia. 14. Quebec Heart and Lung Institute-Laval University, Quebec, Canada. 15. Franciscus Gasthuis Rotterdam, Rotterdam, Netherlands. 16. Polyclinique Lyon Nord, Rillieux-la-Pape, France. 17. Castelfranco Montebelluna Hospitals, Montebelluna, Italy. 18. East Carolina University, Greenville, USA. 19. Makassed General Hospital, Beirut, Lebanon. 20. OB Klinika-Center for Treatment of Obesity and Metabolic Disorders, Prague, Czech Republic. 21. Ain Shams School of Medicine, Cairo, Egypt. 22. Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK. 23. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico. 24. CHIREC Delta Hospital, Brussels, Belgium. 25. Oregon Health & Science University, Portland, USA. 26. Yotsuya Medical Cube, Tokyo, Japan. 27. Phoenix Health, London, UK. 28. Flinders University, Adelaide, South Australia, Australia. 29. Oslo University Hospital, Oslo, Norway. 30. New York University School of Medicine, New York, USA. 31. Dutch Obesity Clinic (NOK), The Hague, Netherlands. 32. University of Illinois, Chicago, USA. 33. University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK. 34. Diakonissen & Wehrle Private Hospital, Salzburg, Austria. 35. Bouchard Private Hospital, Elsan, Marseille, France. 36. Mediclinic Parkview, Dubayy, United Arab Emirates. 37. KF "University Medical Center", Nur-Sultan, Kazakhstan. 38. Istinye University, Istanbul, Turkey. 39. University Hospital Basel, Basel, Switzerland. 40. CHI Memorial Hospital, Chattanooga, TN, USA. 41. Medical University of Vienna, Vienna, Austria. 42. Apollo Hospitals, New Delhi, India. 43. Gem Hospital, Chennai, India. 44. Centro Médico Puerta de Hierro Andares, Zapopan, Mexico. 45. Cleveland Clinic, Weston, FL, USA. 46. Emek Medical Center, Afula, Israel. 47. Jorge Manuel Nunes dos Santos, Lisbon, Portugal. 48. National University Hospital, Singapore, Singapore. 49. Brigham and Women's Hospital, Harvard Medical School, Boston, USA. 50. Concord Repatriation General Hospital, Sydney, Australia. 51. The First Affiliated Hospital of Jinan University, Guangzhou, China. 52. Department for Metabolic Surgery, Sana Klinikum Offenbach, Offenbach, Germany. 53. Medical University of Warsaw, Warsaw, Poland. 54. Cleveland Clinic, Cleveland, USA.
Abstract
INTRODUCTION: Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. METHODS: We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus. RESULTS: The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE. CONCLUSION: A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.
INTRODUCTION: Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. METHODS: We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus. RESULTS: The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE. CONCLUSION: A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.