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. 2020 Jun;34(6):2332-2358.
doi: 10.1007/s00464-020-07555-y. Epub 2020 Apr 23.

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

Nicola Di Lorenzo  1 , Stavros A Antoniou  2   3 , Rachel L Batterham  4   5 , Luca Busetto  6 , Daniela Godoroja  7 , Angelo Iossa  8 , Francesco M Carrano  9 , Ferdinando Agresta  10 , Isaias Alarçon  11 , Carmil Azran  12 , Nicole Bouvy  13 , Carmen Balaguè Ponz  14 , Maura Buza  15 , Catalin Copaescu  15 , Maurizio De Luca  16 , Dror Dicker  17 , Angelo Di Vincenzo  6 , Daniel M Felsenreich  18 , Nader K Francis  19 , Martin Fried  20 , Berta Gonzalo Prats  14 , David Goitein  21   22 , Jason C G Halford  23 , Jitka Herlesova  20 , Marina Kalogridaki  24 , Hans Ket  25 , Salvador Morales-Conde  11 , Giacomo Piatto  16 , Gerhard Prager  18 , Suzanne Pruijssers  13 , Andrea Pucci  4   5 , Shlomi Rayman  21   22 , Eugenia Romano  23 , Sergi Sanchez-Cordero  26 , Ramon Vilallonga  27 , Gianfranco Silecchia  28
Affiliations

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

Nicola Di Lorenzo et al. Surg Endosc. 2020 Jun.

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-to-decision 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.

Conclusion: This document summarizes the latest evidence on bariatric surgery through state-of-the art guideline development, aiming to facilitate evidence-based clinical decisions.

Keywords: AGREE II; Bariatric surgery; EAES; GRADE; Guidelines; Obesity.

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Figures

Fig. 1
Fig. 1
Evidence-based decision tree on the decision for bariatric surgery or conservative management. BMI body mass index. BMI values are kg/m2. Thick arrows and frames, and bold fonts indicate strong recommendation
Fig. 2
Fig. 2
Evidence-based decision tree for preoperative work-up. *Psychological evaluation should be performed when psychological disorders are suspected. Binge eating and depression might not be a contraindication for bariatric/metabolic surgery. Thick arrows and frames, and bold fonts indicate strong recommendation. Dotted arrows and frames indicate conditional recommendation for the intervention. Dashed arrows and frames indicate conditional recommendation against the intervention
Fig. 3
Fig. 3
Evidence-based decision tree for anesthetic and perioperative management. CPAP continuous positive airway pressure, IVCF inferior vena cava filter, ERAS enhanced recovery after surgery. *with minimal use of opioids. Thick arrows and frames, and bold fonts indicate strong recommendation. Dotted arrows and frames indicate conditional recommendation for the intervention. Dashed arrows and frames indicate conditional recommendation against the intervention
Fig. 4
Fig. 4
Evidence-based decision tree for the selection of operative approach. BPD/DS biliopancreatic diversion with duodenal switch, AGB adjustable gastric banding, GERD gastroesophageal reflux disease, RYGB Roux-en-Y gastric bypass. Thick arrows and frames, and bold fonts indicate strong recommendation. Dotted arrows and frames indicate conditional recommendation for the intervention. Dashed arrows and frames indicate conditional recommendation against the intervention
Fig. 5
Fig. 5
Evidence-based decision tree for postoperative follow-up. PPI proton-pump inhibitor. Thick arrows and frames, and bold fonts indicate strong recommendation
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