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

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      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 15 , 16 , 17 , 6 , 18 , 19 , 20 , 14 , 21 , 22 , 23 , 20 , 24 , 25 , 11 , 16 , 18 , 13 , 4 , 5 , 21 , 22 , 23 , 26 , 27 , 8 ,
      Surgical Endoscopy
      Springer US
      Bariatric surgery, Obesity, Guidelines, EAES, GRADE, AGREE II

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          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.

          Electronic supplementary material

          The online version of this article (10.1007/s00464-020-07555-y) contains supplementary material, which is available to authorized users.

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          Most cited references152

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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            The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

            Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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              Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

              Background Long-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited. Methods We assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43 were randomly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications. Results Of the 150 patients who underwent randomization, 1 patient died during the 5-year follow-up period; 134 of the remaining 149 patients (90%) completed 5 years of follow-up. At baseline, the mean (±SD) age of the 134 patients was 49±8 years, 66% were women, the mean glycated hemoglobin level was 9.2±1.5%, and the mean BMI was 37±3.5. At 5 years, the criterion for the primary end point was met by 2 of 38 patients (5%) who received medical therapy alone, as compared with 14 of 49 patients (29%) who underwent gastric bypass (unadjusted P=0.01, adjusted P=0.03, P=0.08 in the intention-to-treat analysis) and 11 of 47 patients (23%) who underwent sleeve gastrectomy (unadjusted P=0.03, adjusted P=0.07, P=0.17 in the intention-to-treat analysis). Patients who underwent surgical procedures had a greater mean percentage reduction from baseline in glycated hemoglobin level than did patients who received medical therapy alone (2.1% vs. 0.3%, P=0.003). At 5 years, changes from baseline observed in the gastric-bypass and sleeve-gastrectomy groups were superior to the changes seen in the medical-therapy group with respect to body weight (-23%, -19%, and -5% in the gastric-bypass, sleeve-gastrectomy, and medical-therapy groups, respectively), triglyceride level (-40%, -29%, and -8%), high-density lipoprotein cholesterol level (32%, 30%, and 7%), use of insulin (-35%, -34%, and -13%), and quality-of-life measures (general health score increases of 17, 16, and 0.3; scores on the RAND 36-Item Health Survey ranged from 0 to 100, with higher scores indicating better health) (P<0.05 for all comparisons). No major late surgical complications were reported except for one reoperation. Conclusions Five-year outcome data showed that, among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia. (Funded by Ethicon Endo-Surgery and others; STAMPEDE ClinicalTrials.gov number, NCT00432809 .).
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                Author and article information

                Contributors
                gianfranco.silecchia@uniroma1.it
                Journal
                Surg Endosc
                Surg Endosc
                Surgical Endoscopy
                Springer US (New York )
                0930-2794
                1432-2218
                23 April 2020
                23 April 2020
                2020
                : 34
                : 6
                : 2332-2358
                Affiliations
                [1 ]GRID grid.6530.0, ISNI 0000 0001 2300 0941, Department of Surgical Sciences, , University of Rome “Tor Vergata”, ; Rome, Italy
                [2 ]GRID grid.440838.3, ISNI 0000 0001 0642 7601, Department of Surgery, , European University of Cyprus, ; Nicosia, Cyprus
                [3 ]Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus
                [4 ]GRID grid.83440.3b, ISNI 0000000121901201, Centre for Obesity Research, , University College London, ; London, UK
                [5 ]GRID grid.451056.3, ISNI 0000 0001 2116 3923, Biomedical Research Centre, , National Institute of Health Research, ; London, UK
                [6 ]GRID grid.411474.3, ISNI 0000 0004 1760 2630, Internal Medicine 3, Department of Medicine, DIMED, Center for the Study and the Integrated Treatment of Obesity, , University Hospital of Padua, ; Padua, Italy
                [7 ]Department of Anesthesiology, Ponderas Academic Hospital Regina Maria, Bucharest, Romania
                [8 ]GRID grid.7841.a, 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, ; Via F. Faggiana 1668, 04100 Latina, Italy
                [9 ]Department of Endocrine and Metabolic Surgery, University of Insubria, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy
                [10 ]Department of General Surgery, ULSS5 del Veneto, Adria, Italy
                [11 ]GRID grid.411109.c, ISNI 0000 0000 9542 1158, Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, , University Hospital “Virgen del Rocío”, ; 41010 Sevilla, Spain
                [12 ]GRID grid.435296.f, ISNI 0000 0004 0631 0413, Herzliya Medical Center, ; Herzliya, Israel
                [13 ]GRID grid.412966.e, ISNI 0000 0004 0480 1382, Department of Surgery, , Maastricht University Medical Centre, ; Maastricht, The Netherlands
                [14 ]GRID grid.413396.a, ISNI 0000 0004 1768 8905, Hospital Sant Pau, UAB, ; Barcelona, Spain
                [15 ]Department of General Surgery, Ponderas Academic Hospital Regina Maria, Bucharest, Romania
                [16 ]Division of General Surgery, Castelfranco and Montebelluna Hospitals, Treviso, Italy
                [17 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, , Tel Aviv University, ; Tel Aviv, Israel
                [18 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Division of General Surgery, Department of Surgery, , Vienna Medical University, ; Vienna, Austria
                [19 ]GRID grid.440204.6, ISNI 0000 0004 0487 0310, Department of General Surgery, , Yeovil District Hospital NHS Foundation Trust, ; Yeovil, UK
                [20 ]Center for Treatment of Obesity and Metabolic Disorders, OB Klinika, Prague, Czech Republic
                [21 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Sackler School of Medicine, , Tel Aviv University, ; Tel Aviv, Israel
                [22 ]GRID grid.413795.d, ISNI 0000 0001 2107 2845, Department of Surgery C, , Chaim Sheba Medical Center, ; Ramat Gan, Israel
                [23 ]GRID grid.10025.36, ISNI 0000 0004 1936 8470, Department of Psychological Sciences, Institute of Psychology, Health and Society, , University of Liverpool, ; Liverpool, UK
                [24 ]GRID grid.415070.7, ISNI 0000 0004 0622 8129, Emergency Department, , General Hospital of Attica “KAT”, ; Athens, Greece
                [25 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, VU Amsterdam, ; Amsterdam, Netherlands
                [26 ]General Surgery Department, Consorci Sanitari de L’Anoia, Barcelona, Spain
                [27 ]GRID grid.7080.f, 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
                Article
                7555
                10.1007/s00464-020-07555-y
                7214495
                32328827
                eef5059f-7a51-4976-acc5-75f30dcfa4db
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 24 February 2020
                : 7 April 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100012161, European Association for Endoscopic Surgery and other Interventional Techniques;
                Categories
                Guidelines
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2020

                Surgery
                bariatric surgery,obesity,guidelines,eaes,grade,agree ii
                Surgery
                bariatric surgery, obesity, guidelines, eaes, grade, agree ii

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