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Patient Selection in One Anastomosis/Mini Gastric Bypass—An Expert Modified Delphi Consensus Publisher Pubmed



Kermansaravi M1 ; Parmar C2 ; Chiappetta S3 ; Shahabi S1 ; Abbass A4 ; Abbas SI5 ; Abouzeid M4 ; Antozzi L6 ; Asghar ST7 ; Bashir A8 ; Bhandari M9 ; Billy H10 ; Caina D11 ; Campos FJ12 Show All Authors
Authors
  1. Kermansaravi M1
  2. Parmar C2
  3. Chiappetta S3
  4. Shahabi S1
  5. Abbass A4
  6. Abbas SI5
  7. Abouzeid M4
  8. Antozzi L6
  9. Asghar ST7
  10. Bashir A8
  11. Bhandari M9
  12. Billy H10
  13. Caina D11
  14. Campos FJ12
  15. Carbajo MA13
  16. Chevallier JM14
  17. Jazi AHD1
  18. De Gordejuela AGR15
  19. Haddad A8
  20. Elfawal MH16
  21. Himpens J17
  22. Inam A18
  23. Kassir R19
  24. Kasama K20
  25. Khan A21
  26. Kow L22
  27. Kular KS23
  28. Lakdawala M24
  29. Layani L25
  30. Lee WJ26
  31. Luquedeleon E27
  32. Loi K28
  33. Mahawar K29
  34. Mahdy T30
  35. Musella M31
  36. Nimeri A32
  37. Gonzalez JCO33
  38. Pazouki A1
  39. Poghosyan T34
  40. Prager G35
  41. Prasad A36
  42. Ramos AC37
  43. Rheinwalt K38
  44. Ribeiro R39
  45. Ruizucar E40
  46. Rutledge R41
  47. Shabbir A42
  48. Shikora S43
  49. Singhal R44
  50. Taha O45
  51. Talebpour M46
  52. Verboonen JS47
  53. Wang C48
  54. Weiner R49
  55. Yang W48
  56. Vilallonga R50
  57. De Luca M51
Show Affiliations
Authors Affiliations
  1. 1. Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
  2. 2. Whittington Hospital, London, United Kingdom
  3. 3. Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
  4. 4. Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
  5. 5. Iranian Hospital, Al Wasl Road, Dubai, United Arab Emirates
  6. 6. Centro de Cirugias Especiales, Bahia Blanca, Argentina
  7. 7. Capital Hospital, CDA, Islamabad, Pakistan
  8. 8. Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
  9. 9. Mohak Bariatrics and Robotics Center, Indore, India
  10. 10. Ventura Advanced Surgical Associates, Ventura, CA, United States
  11. 11. Dr. Federico Abete Hospital for Trauma and Emergency, Obesity and Metabolic Center, Malvinas, Argentina
  12. 12. Obesity Clinic, Mexico City, Mexico
  13. 13. Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
  14. 14. Universite Paris 5, Paris, France
  15. 15. Vall d’Hebron University Hospital, Barcelona, Spain
  16. 16. Makassed General Hospital, Beirut, Lebanon
  17. 17. Bariatric Surgery Unit, Delta Chirec Hospital, Brussels, Belgium
  18. 18. Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
  19. 19. Department of Digestive Surgery, CHU Felix Guyon, Saint Denis, La Reunion, France
  20. 20. Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
  21. 21. Walsall Healthcare NHS Trust, Walsall, United Kingdom
  22. 22. Flinders Medical Centre, Adelaide, Australia
  23. 23. Kular Research Institute, Bija, India
  24. 24. Sir H N Reliance Foundation Hospital, Mumbai, India
  25. 25. Al Sharq Hospital, Fujairah, United Arab Emirates
  26. 26. Min-Sheng General Hospital, Taoyuan City, Taiwan
  27. 27. The American British Cowdray Medical Center, Mexico City, Mexico
  28. 28. St George Surgery, Sydney, Australia
  29. 29. South Tyneside and Sunderland Foundation NHS Trust, Sunderland, United Kingdom
  30. 30. Mansoura Faculty of Medicine, Sharjah University Hospital, Sharjah, United Arab Emirates
  31. 31. Advanced Biomedical Sciences Department, “Federico II� University, Naples, Italy
  32. 32. Atrium Health, Charlotte, NC, United States
  33. 33. Obesity Surgeons Mexico, Tamaulipas, Reynosa, Mexico
  34. 34. Hopital Europeen-Georges Pompidou, AP-HP, Universite de Paris, Paris, France
  35. 35. Medical University of Vienna, Vienna, Austria
  36. 36. Apollo Hospital, New Delhi, India
  37. 37. Institute for Metabolic Optimization, Sao Paulo, Brazil
  38. 38. Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany
  39. 39. Centro de Excelencia Para a Cirurgia MetabolicaGrupo Lusiadas, Lisbon, Portugal
  40. 40. Bariatric and Metabolic Surgery Department, University Hospital of Fuenlabrada, Madrid, Spain
  41. 41. International Center for Laparoscopic Obesity Surgery, Punjab, India
  42. 42. National University of Singapore, Singapore, Singapore
  43. 43. Department of Surgery Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
  44. 44. University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  45. 45. Plastic and Obesity Surgery Department, Bariatric Unit, Assiut University Hospital, Assiut, Egypt
  46. 46. Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  47. 47. Obesity Goodbye Center, Tijuana, Mexico
  48. 48. Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
  49. 49. Bariatric Surgery Unit, Sana Clinic Offenbach, Offenbach, Germany
  50. 50. Endocrine, Bariatric and Metabolic Surgery Department, Universitary Hospital Vall Hebron, Barcelona, Spain
  51. 51. Department of General Surgery, Rovigo Hospital, Rovigo, Italy

Source: Obesity Surgery Published:2022


Abstract

Purpose: One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. Methods: A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. Results: Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option “in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure,” “as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS),” and “in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved “in case of intestinal metaplasia of the stomach” (74.55%), “in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)” (75.44%), “in patients with Barrett’s metaplasia” (89.29%), and “in documented insulinoma” (89.47%). Conclusion: Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30–35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett’s metaplasia. Graphical abstract: [Figure not available: see fulltext.] © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.