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, Stavros A Antoniou, Rachel L Batterham, Luca Busetto, Daniela Godoroja, Angelo Iossa, Francesco M Carrano, Ferdinando Agresta, Isaias Alarçon, Carmil Azran, Nicole Bouvy, Carmen Balaguè Ponz, Maura Buza, Catalin Copaescu, Maurizio De Luca, Dror Dicker, Angelo Di Vincenzo, Daniel M Felsenreich, Nader K Francis, Martin Fried, Berta Gonzalo Prats, David Goitein, Jason C G Halford, Jitka Herlesova, Marina Kalogridaki, Hans Ket, Salvador Morales-Conde, Giacomo Piatto, Gerhard Prager, Suzanne Pruijssers, Andrea Pucci, Shlomi Rayman, Eugenia Romano, Sergi Sanchez-Cordero, Ramon Vilallonga, Gianfranco Silecchia, Nicola Di Lorenzo, Stavros A Antoniou, Rachel L Batterham, Luca Busetto, Daniela Godoroja, Angelo Iossa, Francesco M Carrano, Ferdinando Agresta, Isaias Alarçon, Carmil Azran, Nicole Bouvy, Carmen Balaguè Ponz, Maura Buza, Catalin Copaescu, Maurizio De Luca, Dror Dicker, Angelo Di Vincenzo, Daniel M Felsenreich, Nader K Francis, Martin Fried, Berta Gonzalo Prats, David Goitein, Jason C G Halford, Jitka Herlesova, Marina Kalogridaki, Hans Ket, Salvador Morales-Conde, Giacomo Piatto, Gerhard Prager, Suzanne Pruijssers, Andrea Pucci, Shlomi Rayman, Eugenia Romano, Sergi Sanchez-Cordero, Ramon Vilallonga, Gianfranco Silecchia

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.

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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