Updated Guidelines: Sleeve Gastrectomy No Longer Investigational

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According to new guidelines cosponsored by the American Society for Metabolic & Bariatric Surgery, the American Association of Clinical Endocrinologists and The Obesity Society, the Sleeve Gastrectomy procedure, an effective form of bariatric surgery, should no longer be considered investigational

Since 2008, the last update to the guidelines, studies have demonstrated that the sleeve gastrectomy procedure results in comparable total weight loss to that achieved with gastric banding and gastric bypass, stated Adrienne Youdim, MD, of Cedars-Sinai Weight Loss Center in Los Angeles, and colleagues who wrote the updated guideline that were published in the March 2013 issue of Obesity.

Dr. Youdim was quoted in MedPage Today saying that sleeve gastrectomy has “historically been used in patients who are too high risk for gastric bypass, but as more data have been collected on outcomes with sleeve gastrectomy, it has become clear that this surgery is effective in its own right,”.

A co-author of the guidelines and president-elect of AACE,Jeffrey Mechanick, MD, of Mount Sinai in New York City, stated that the guidelines needed an update because “there’s a lot of new information that’s relevant to clinical practice.”

Despite this upgrade for the sleeve gastrectomy procedure, the new guidelines do not recommend one procedure as preferred over others. The authors did not believe that it was appropriate to recommend one procedure over another leaving that decision to regional expertise.

However, the authors did warn that clinicians should be more cautious with the aggressive biliopancreatic diversion with duodenal switch procedure as well as discussing the shorter-lived results and less robust weight loss seen with gastric band procedure.

In terms of resulting weight loss, the sleeve gastrectomy procedure falls between the gastric band and the gastric bypass procedure.

Additionally, the new guidelines discussed the characteristics of a good candidate for the various procedures as well as the mounting evidence for using bariatric surgery as “metabolic” surgery to treat conditions such as type 2 diabetes.

The new guidelines suggest that bariatric surgery may be offered to patients with a BMI of 30 to 34.9 who have type 2 diabetes, though the current evidence is limited .

In 2011, gastric banding for this patient population was approved by the FDA.

The strongest evidence supporting that bariatric surgery is safe and effective was seen in two groups of patients: those with a BMI of 40 or greater, and those with a BMI of 35 or great with comorbidities.

Since the last guidelines were issued in 2008, overall mortality rates have improved with a large study from Sweden showing a nearly 30% reduced risk of death over the 10 years following surgery, and a relatred study showing a nearly 50% reduced risk of death over 20 years.

Dr. Youdim mentioned that many of the 2008 recommendations are “now backed by a higher level of evidence.” Dr. Mechanick added that the new guidelines to bariatric surgery put an emphasis on a team approach helping prevent and treat possible complications that may arise such as metabolic disease.

By Staff @ MexicaliMedicalGuide
April 8, 2013

Source reference:
Mechanick JI, et al “Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient — 2013 update” Obesity 2013; DOI: 10.1002/oby.20461.

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