The first consensus statement on revisional bariatric surgery using a modified Delphi approach

Mahawar, Kamal; Himpens, Jacques; Shikora, Scott A.; Ramos, Almino Cardoso; Torres, Antonio; Somers, Shaw; Dillemans, Bruno; Angrisani, Luigi; Greve, Jan-Willem M.; Chevallier, Jean Marc; Chowbey, Pradeep; Luca, Maurizio De; Weiner, R; Prager, Gerhard; Vilallonga, Ramón; Adamo, Marco; Sakran, Nasser; Kow, Lilian; Lakdawala, Mufazzal; Dargent, J.; Nimeri, Abdelrahman; Small, Peter P.K.

doi:10.1007/s00464-019-06937-1

Cited by 69 publications

(61 citation statements)

References 17 publications

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“…Consensus statements are recognised to be useful for identifying the most pragmatic course of action in areas of a poor evidence base. Modified Delphi consensus-building strategies are known to be more robust than traditional consensus-building approaches, which can often be hijacked by loud voices, and have been successfully used before in a multitude of clinical settings [ 5 , 6 ]…”

Section: Discussionmentioning

confidence: 99%

“…In the second round, the committee voted on only those statements where there was an agreement/disagreement of ≥ 60.0% but not enough to reach the consensus threshold of 70.0%. The committee did not vote again on statements with an agreement/disagreement of < 60.0% in the first round, as previous consensus-building exercises have shown that these statements rarely achieve consensus even after the second round of voting [ 5 , 6 ]. The committee also introduced 23 new statements in the second round to further clarify some of the statements voted on in the first round.…”

Section: Methodsmentioning

confidence: 99%

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The First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times

et al. 2020

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The purpose of this study was to achieve consensus amongst a global panel of expert bariatric surgeons on various aspects of resuming Bariatric and Metabolic Surgery (BMS) during the Coronavirus Disease-2019 (COVID-19) pandemic. A modified Delphi consensus-building protocol was used to build consensus amongst 44 globally recognised bariatric surgeons. The experts were asked to either agree or disagree with 111 statements they collectively proposed over two separate rounds. An agreement amongst ≥ 70.0% of experts was construed as consensus as per the predetermined methodology. We present here 38 of our key recommendations. This first global consensus statement on the resumption of BMS can provide a framework for multidisciplinary BMS teams planning to resume local services as well as guide future research in this area.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times

et al. 2020

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“…However, the potential for relapse is concerning and has prompted additional surgical procedures (“revisional surgery”) (22) aiming to increase malabsorption (“distalization”) (23), increase the restriction at the gastro‐jejunal anastomosis (24) (sclerotherapy) (25), and correct anatomical defects such as gastro‐gastric fistulas (26). Unfortunately, position statements and guidelines related to the implementation of surgical revisions continue to rely on expert opinion (27) rather than on controlled prospective studies. Thus, nonsurgical interventions remain crucial for counteracting the growing problem of WR following bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

The Mitigating Effect of Phentermine and Topiramate on Weight Regain After Roux‐en‐Y Gastric Bypass Surgery

Istfan

Anderson

Hess

et al. 2020

Obesity

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Objective Weight regain (WR) after Roux‐en‐Y gastric bypass surgery (RYGB) starts to occur 2 years after surgery, ultimately affecting at least 25% of patients. A limited number of studies have evaluated the impact of antiobesity medications (AOMs) on this phenomenon. Methods This study reviewed the electronic medical records of 1,196 patients who underwent RYGB between 2004 and 2015. WR was evaluated by comparing each patient’s weight during subsequent postoperative office visits to nadir weight (lowest weight after RYGB, n = 760), taking into consideration the interval during which WR occurred. Patients who were prescribed AOMs and came to follow‐up visits were classified as adherent users, whereas those who missed their follow‐up visits were considered nonadherent. This study used a linear mixed model, Cox regression, and generalized equation estimator to determine the impact of AOMs on WR trajectory, hazard ratio for time to event, and odds ratio for repeated event occurrence, respectively. Results Despite the lack of a unified protocol for using AOMs, the three statistical models converged to show that phentermine and topiramate, used individually or in combination, can significantly reduce WR after RYGB. Conclusions Phentermine and topiramate are effective in mitigating WR after RYGB. Further studies are needed to help ascertain optimal use of AOMs after bariatric surgery.

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“…Endoscopy may represent a less invasive, less morbid first step in the management of weight regain compared with surgical revision. 55 As the correlation between RYGB anastomotic dilatation and weight regain 56 has been determined, endoscopic revision procedures have gained a pivotal role in managing weight regain after bariatric surgery. There are different techniques such as APC, TORe (Figure 1(a)), and restorative obesity surgery endolumenally (ROSE).…”

Section: Br Trainingmentioning

confidence: 99%

Training in bariatric and metabolic endoscopy

Spota

Laracca

Perretta

2020

Clin Med Insights Gastroenterol

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The limited penetration of bariatric surgery and the scarce outcome of pharmacological therapies created a favorable space for primary bariatric endoscopic techniques. Furthermore, bariatric endoscopy is largely used to diagnose and treat surgical complications and weight regain after bariatric surgery. The increasingly essential role of endoscopy in the management of obese patients results in the need for trained professionals. Training methods are evolving, and the apprenticeship method is giving way to the simulation-based method. Existing simulation platforms include mechanical simulators, ex vivo and in vivo models, and virtual reality simulators. This review analyzes current training methods for bariatric endoscopy and available training programs with dedicated bariatric core curricula, giving a glimpse of future perspectives.

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The first consensus statement on revisional bariatric surgery using a modified Delphi approach

Cited by 69 publications

References 17 publications

The First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times

The First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times

The Mitigating Effect of Phentermine and Topiramate on Weight Regain After Roux‐en‐Y Gastric Bypass Surgery

Training in bariatric and metabolic endoscopy

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