Patient Selection in One Anastomosis/Mini Gastric Bypass-an Expert Modified Delphi Consensus.
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Kermansaravi Mohammad, Parmar Chetan, Chiappetta Sonja, Shahabi Shahab, Abbass Alaa, Abbas Syed Imran, Abouzeid Mohamed, Antozzi Luciano, Asghar Syed Tanseer, Bashir Ahmad, Bhandari Mohit, Billy Helmuth, Caina Daniel, Campos Francisco J, Carbajo Miguel-A, Chevallier Jean Marc, Jazi Amir Hossein Davarpanah, de Gordejuela Amador Garcia Ruiz, Haddad Ashraf, ElFawal Mohamad Hayssam, Himpens Jacques, Inam Aatif, Kassir Radwan, Kasama Kazunori, Khan Amir, Kow Lilian, Kular Kuldeepak Singh, Lakdawala Muffazal, Layani Laurent Abram, Lee Wei-Jei, Luque-de-León Enrique, Loi Ken, Mahawar Kamal, Mahdy Tarek, Musella Mario, Nimeri Abdelrahman, González Juan Carlos Olivares, Pazouki Abdolreza, Poghosyan Tigran, Prager Gerhard, Prasad Arun, Ramos Almino C, Rheinwalt Karl, Ribeiro Rui, Ruiz-Úcar Elena, Rutledge Robert, Shabbir Asim, Shikora Scott, Singhal Rishi, Taha Osama, Talebpour Mohammad, Verboonen Jose Sergio, Wang Cunchuan, Weiner Rudolf, Yang Wah, Vilallonga Ramon, De Luca Maurizio
Аннотация
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.