Francesco M Carrano1, Angelo Iossa2, Nicola Di Lorenzo3, Gianfranco Silecchia2, Katerina-Maria Kontouli4, Dimitris Mavridis4,5, Isaias Alarçon6, Daniel M Felsenreich7, Sergi Sanchez-Cordero8, Angelo Di Vincenzo9, M Carmen Balagué-Ponz10, Rachel L Batterham11,12, Nicole Bouvy13, Catalin Copaescu14, Dror Dicker15, Martin Fried16, Daniela Godoroja17, David Goitein18,19, Jason C G Halford20, Marina Kalogridaki21, Maurizio De Luca22, Salvador Morales-Conde6, Gerhard Prager7, Andrea Pucci11,12, Ramon Vilallonga23, Iris Zani24, Per Olav Vandvik25, Stavros A Antoniou26,27. 1. PhD Program in Applied Medical-Surgical Sciences, University of Rome "Tor Vergata", 00133, Rome, Italy. 2. Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "La Sapienza" University of Rome-Polo Pontino, Bariatric Centre of Excellence IFSO-EC, Rome, Italy. 3. Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy. 4. Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece. 5. Faculté de Médecine, Université Paris Descartes, Paris, France. 6. Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocío", 41010, Sevilla, Spain. 7. Department of Surgery, Division of General Surgery, Vienna Medical University, Vienna, Austria. 8. General Surgery Department, Consorci Sanitari de L'Anoia, Barcelona, Spain. 9. Internal Medicine 3, Department of Medicine, DIMED; Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy. 10. Hospital Sant Pau, UAB, Barcelona, Spain. 11. Centre for Obesity Research, University College London, London, UK. 12. Biomedical Research Centre, National Institute of Health Research, London, UK. 13. Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 14. Department of General Surgery, Ponderas Academic Hospital Regina Maria, Bucharest, Romania. 15. Department of Internal Medicine D, Rabin Medical Center, Hasharon Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 16. Center for Treatment of Obesity and Metabolic Disorders, OB Klinika, Prague, Czech Republic. 17. Department of Anesthesiology, Ponderas Academic Hospital Regina Maria, Bucharest, Romania. 18. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 19. Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel. 20. Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK. 21. Emergency Department, General Hospital of Attica "KAT", Athens, Greece. 22. Division of General Surgery, Castelfranco and Montebelluna Hospitals, Treviso, Italy. 23. Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain. 24. EASO Patient Task Force, Middlesex, UK. 25. Department of Health Management and Health Economics, University of Oslo, Oslo, Norway. 26. Surgical Department, Mediterranean Hospital of Cyprus, Limassol, Cyprus. guidelines@eaes.eu. 27. Medical School, European University Cyprus, Nicosia, Cyprus. guidelines@eaes.eu.
Abstract
BACKGROUND: The European Association for Endoscopic Surgery Bariatric Guidelines Group identified a gap in bariatric surgery recommendations with a structured, contextualized consideration of multiple bariatric interventions. OBJECTIVE: To provide evidence-informed, transparent and trustworthy recommendations on the use of sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, gastric plication, biliopancreatic diversion with duodenal switch, one anastomosis gastric bypass, and single anastomosis duodeno-ileal bypass with sleeve gastrectomy in patients with severe obesity and metabolic diseases. Only laparoscopic procedures in adults were considered. METHODS: A European interdisciplinary panel including general surgeons, obesity physicians, anesthetists, a psychologist and a patient representative informed outcome importance and minimal important differences. We conducted a systematic review and frequentist fixed and random-effects network meta-analysis of randomized-controlled trials (RCTs) using the graph theory approach for each outcome. We calculated the odds ratio or the (standardized) mean differences with 95% confidence intervals for binary and continuous outcomes, respectively. We assessed the certainty of evidence using the CINeMA and GRADE methodologies. We considered the risk/benefit outcomes within a GRADE evidence to decision framework to arrive at recommendations, which were validated through an anonymous Delphi process of the panel. RESULTS: We identified 43 records reporting on 24 RCTs. Most network information surrounded sleeve gastrectomy and Roux-en-Y gastric bypass. Under consideration of the certainty of the evidence and evidence to decision parameters, we suggest sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass over adjustable gastric banding, biliopancreatic diversion with duodenal switch and gastric plication for the management of severe obesity and associated metabolic diseases. One anastomosis gastric bypass and single anastomosis duodeno-ileal bypass with sleeve gastrectomy are suggested as alternatives, although evidence on benefits and harms, and specific selection criteria is limited compared to sleeve gastrectomy and Roux-en-Y gastric bypass. The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/Lpv2kE CONCLUSIONS: This rapid guideline provides evidence-informed, pertinent recommendations on the use of bariatric and metabolic surgery for the management of severe obesity and metabolic diseases. The guideline replaces relevant recommendations published in the EAES Bariatric Guidelines 2020.
BACKGROUND: The European Association for Endoscopic Surgery Bariatric Guidelines Group identified a gap in bariatric surgery recommendations with a structured, contextualized consideration of multiple bariatric interventions. OBJECTIVE: To provide evidence-informed, transparent and trustworthy recommendations on the use of sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, gastric plication, biliopancreatic diversion with duodenal switch, one anastomosis gastric bypass, and single anastomosis duodeno-ileal bypass with sleeve gastrectomy in patients with severe obesity and metabolic diseases. Only laparoscopic procedures in adults were considered. METHODS: A European interdisciplinary panel including general surgeons, obesity physicians, anesthetists, a psychologist and a patient representative informed outcome importance and minimal important differences. We conducted a systematic review and frequentist fixed and random-effects network meta-analysis of randomized-controlled trials (RCTs) using the graph theory approach for each outcome. We calculated the odds ratio or the (standardized) mean differences with 95% confidence intervals for binary and continuous outcomes, respectively. We assessed the certainty of evidence using the CINeMA and GRADE methodologies. We considered the risk/benefit outcomes within a GRADE evidence to decision framework to arrive at recommendations, which were validated through an anonymous Delphi process of the panel. RESULTS: We identified 43 records reporting on 24 RCTs. Most network information surrounded sleeve gastrectomy and Roux-en-Y gastric bypass. Under consideration of the certainty of the evidence and evidence to decision parameters, we suggest sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass over adjustable gastric banding, biliopancreatic diversion with duodenal switch and gastric plication for the management of severe obesity and associated metabolic diseases. One anastomosis gastric bypass and single anastomosis duodeno-ileal bypass with sleeve gastrectomy are suggested as alternatives, although evidence on benefits and harms, and specific selection criteria is limited compared to sleeve gastrectomy and Roux-en-Y gastric bypass. The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/Lpv2kE CONCLUSIONS: This rapid guideline provides evidence-informed, pertinent recommendations on the use of bariatric and metabolic surgery for the management of severe obesity and metabolic diseases. The guideline replaces relevant recommendations published in the EAES Bariatric Guidelines 2020.
Authors: Amir Qaseem; Frode Forland; Fergus Macbeth; Günter Ollenschläger; Sue Phillips; Philip van der Wees Journal: Ann Intern Med Date: 2012-04-03 Impact factor: 25.391
Authors: Romina Brignardello-Petersen; M Hassan Murad; Stephen D Walter; Shelley McLeod; Alonso Carrasco-Labra; Bram Rochwerg; Holger J Schünemann; George Tomlinson; Gordon H Guyatt Journal: J Clin Epidemiol Date: 2018-09-22 Impact factor: 6.437
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Authors: Nicola Di Lorenzo; Stavros A Antoniou; Rachel L Batterham; Luca Busetto; Daniela Godoroja; Angelo Iossa; Francesco M Carrano; Ferdinando Agresta; Isaias Alarçon; Carmil Azran; Nicole Bouvy; Carmen Balaguè Ponz; Maura Buza; Catalin Copaescu; Maurizio De Luca; Dror Dicker; Angelo Di Vincenzo; Daniel M Felsenreich; Nader K Francis; Martin Fried; Berta Gonzalo Prats; David Goitein; Jason C G Halford; Jitka Herlesova; Marina Kalogridaki; Hans Ket; Salvador Morales-Conde; Giacomo Piatto; Gerhard Prager; Suzanne Pruijssers; Andrea Pucci; Shlomi Rayman; Eugenia Romano; Sergi Sanchez-Cordero; Ramon Vilallonga; Gianfranco Silecchia Journal: Surg Endosc Date: 2020-04-23 Impact factor: 4.584