Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus
Abstract
Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.
Author
Kermansaravi, Mohammad
Chiappetta, Sonja
Parmar, Chetan
Shikora, Scott A
Prager, Gerhard
LaMasters, Teresa
Ponce, Jaime
Kow, Lilian
Nimeri, Abdelrahman
Kothari, Shanu N
Aarts, Edo
Abbas, Syed Imran
Aly, Ahmad
Aminian, Ali
Bashir, Ahmad
Behrens, Estuardo
Billy, Helmuth
Carbajo, Miguel A
Clapp, Benjamin
Chevallier, Jean-Marc
Cohen, Ricardo V
Dargent, Jerome
Dillemans, Bruno
Faria, Silvia L
Neto, Manoel Galvao
Garneau, Pierre Y
Gawdat, Khaled
Haddad, Ashraf
ElFawal, Mohamad Hayssam
Higa, Kelvin
Himpens, Jaques
Husain, Farah
Hutter, Matthew M
Kasama, Kazunori
Kassir, Radwan
Khan, Amir
Khoursheed, Mousa
Kroh, Matthew
Kurian, Marina S
Lee, Wei-Jei
Loi, Ken
Mahawar, Kamal
McBride, Corrigan L
Almomani, Hazem
Melissas, John
Miller, Karl
Misra, Monali
Musella, Mario
Northup, C Joe
O'Kane, Mary
Papasavas, Pavlos K
Palermo, Mariano
Peterson, Richard M
Peterli, Ralph
Poggi, Luis
Pratt, Janey S A
Alqahtani, Aayad
Ramos, Almino C
Rheinwalt, Karl
Ribeiro, Rui
Rogers, Ann M
Safadi, Bassem
Salminen, Paulina
Santoro, Sergio
Sann, Nathaniel
Scott, John D
Shabbir, Asim
Sogg, Stephanie
Stenberg, Erik
Suter, Michel
Torres, Antonio
Ugale, Surendra
Vilallonga, Ramon
Wang, Cunchuan
Weiner, Rudolf
Zundel, Natan
Angrisani, Luigi
De Luca, Maurizio
Chiappetta, Sonja
Parmar, Chetan
Shikora, Scott A
Prager, Gerhard
LaMasters, Teresa
Ponce, Jaime
Kow, Lilian
Nimeri, Abdelrahman
Kothari, Shanu N
Aarts, Edo
Abbas, Syed Imran
Aly, Ahmad
Aminian, Ali
Bashir, Ahmad
Behrens, Estuardo
Billy, Helmuth
Carbajo, Miguel A
Clapp, Benjamin
Chevallier, Jean-Marc
Cohen, Ricardo V
Dargent, Jerome
Dillemans, Bruno
Faria, Silvia L
Neto, Manoel Galvao
Garneau, Pierre Y
Gawdat, Khaled
Haddad, Ashraf
ElFawal, Mohamad Hayssam
Higa, Kelvin
Himpens, Jaques
Husain, Farah
Hutter, Matthew M
Kasama, Kazunori
Kassir, Radwan
Khan, Amir
Khoursheed, Mousa
Kroh, Matthew
Kurian, Marina S
Lee, Wei-Jei
Loi, Ken
Mahawar, Kamal
McBride, Corrigan L
Almomani, Hazem
Melissas, John
Miller, Karl
Misra, Monali
Musella, Mario
Northup, C Joe
O'Kane, Mary
Papasavas, Pavlos K
Palermo, Mariano
Peterson, Richard M
Peterli, Ralph
Poggi, Luis
Pratt, Janey S A
Alqahtani, Aayad
Ramos, Almino C
Rheinwalt, Karl
Ribeiro, Rui
Rogers, Ann M
Safadi, Bassem
Salminen, Paulina
Santoro, Sergio
Sann, Nathaniel
Scott, John D
Shabbir, Asim
Sogg, Stephanie
Stenberg, Erik
Suter, Michel
Torres, Antonio
Ugale, Surendra
Vilallonga, Ramon
Wang, Cunchuan
Weiner, Rudolf
Zundel, Natan
Angrisani, Luigi
De Luca, Maurizio
Citations
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Date
2024-02-11
Type
Article
Subject
Surgery
Collections
Citation
Kermansaravi M, Chiappetta S, Parmar C, Shikora SA, Prager G, LaMasters T, Ponce J, Kow L, Nimeri A, Kothari SN, Aarts E, Abbas SI, Aly A, Aminian A, Bashir A, Behrens E, Billy H, Carbajo MA, Clapp B, Chevallier JM, Cohen RV, Dargent J, Dillemans B, Faria SL, Neto MG, Garneau PY, Gawdat K, Haddad A, ElFawal MH, Higa K, Himpens J, Husain F, Hutter MM, Kasama K, Kassir R, Khan A, Khoursheed M, Kroh M, Kurian MS, Lee WJ, Loi K, Mahawar K, McBride CL, Almomani H, Melissas J, Miller K, Misra M, Musella M, Northup CJ, O'Kane M, Papasavas PK, Palermo M, Peterson RM, Peterli R, Poggi L, Pratt JSA, Alqahtani A, Ramos AC, Rheinwalt K, Ribeiro R, Rogers AM, Safadi B, Salminen P, Santoro S, Sann N, Scott JD, Shabbir A, Sogg S, Stenberg E, Suter M, Torres A, Ugale S, Vilallonga R, Wang C, Weiner R, Zundel N, Angrisani L, De Luca M. Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus. Sci Rep. 2024 Feb 11;14(1):3445.
Journal / Source Title
Scientific Reports
DOI
10.1038/s41598-024-54141-6
PMID
38341469
Publisher
Nature Research