Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery

Jeffrey I Mechanick, Adrienne Youdim, Daniel B Jones, W Timothy Garvey, Daniel L Hurley, M Molly McMahon, Leslie J Heinberg, Robert Kushner, Ted D Adams, Scott Shikora, John B Dixon, Stacy Brethauer, American Association of Clinical Endocrinologists, Obesity Society, American Society for Metabolic & Bariatric Surgery, Jeffrey I Mechanick, Adrienne Youdim, Daniel B Jones, W Timothy Garvey, Daniel L Hurley, M Molly McMahon, Leslie J Heinberg, Robert Kushner, Ted D Adams, Scott Shikora, John B Dixon, Stacy Brethauer, American Association of Clinical Endocrinologists, Obesity Society, American Society for Metabolic & Bariatric Surgery

Abstract

The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

Conflict of interest statement

Disclosures

Jeffrey I. Mechanick, M.D.: Abbott Nutrition, honoraria for lectures and program development. Daniel B. Jones, M.D., M.S.: Allurion, consultant. W. Timothy Garvey, M.D.: Merck, speakers list; Daiichi-Sanyo, Vivus, Alkermes, Liposcience, Tethys Bioscience, advisory boards; Merck, Amylin, Weight Watchers, research. Scott Shikora, M.D.: Baxter Healthcare, consultant; EnteroMedics, consultant; GI Dynamics, stock options for previous consultant work. John B. Dixon, M.B.B.S., Ph.D.: Consultant for Allergan Inc. and Bariatric Advantage Inc.; Scientific Advisory Board for OPTIFAST(R), Nestle Australia; developed educational material and is on the speakers’ bureau for iNova Pharmaceuticals; Institutions receive research assistance from Allergan Inc. and Nestle Australia. Robin Blackstone, M.D.: Enteromedics PI and Johnson and Johnson, consultant. Alan Garber, M.D.: Novo Nordisk, Daiichi Sankyo, Merck, Takeda, Santarus, LipoScience, Boehringer Ingelheim, Tethys, Lexicon, Vivus, consultant; Novo Nordisk, Daiichi Sankyo, Merck, Takeda, LipoScience, Boehringer Ingelheim, advisory board; Merck, Novo Nordisk, Santarus, Daiichi Sankyo, Speakers Bureau. Stacy Brethauer, M.D.: Ethicon Endo-Surgery, consultant and Advisory Board member. David B. Sarwer, Ph.D.: Allergan, BaroNova, EnteroMedics, Ethicon Endo- Surgery, Galderma, consultant. Bruce Wolfe, M.D.: EnteroMedics, investigator. Adrienne Youdim, M.D., Daniel L. Hurley, M.D., M. Molly McMahon, M.D., Leslie J. Heinberg, Ph.D., Robert Kushner, M.D., Ted Adams, Ph.D., M.P.H., George Blackburn, M.D., Ph.D., and Christopher D. Still, D.O., report no potential conflicts of interest.

Copyright © 2013 The Obesity Society.

Figures

Figure 1
Figure 1
Common types of bariatric surgery procedures. (A) Adjustable gastric band; (B) sleeve gastrectomy; (C) Roux-en-Y gastric bypass; (D) biliopancreatic diversion with duodenal switch. (Illustrations reprinted with permission from Atlas of Metabolic and Weight Loss Surgery, Jones et al. Cine-Med, 2010. Copyright of the book and illustrations are retained by Cine-Med.)

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Source: PubMed

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