American Society for Metabolic and Bariatric Surgery Position Statement on emerging endosurgical interventions for treatment of obesity

doi:10.1016/j.soard.2009.02.001

Surgery for Obesity and Related Diseases

Volume 5, Issue 3, May–June 2009, Pages 297-298

https://doi.org/10.1016/j.soard.2009.02.001 Get rights and content

Abstract

The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to numerous inquiries made to the Society by patients, physicians, society members, hospitals, health insurance payors, the media, and others regarding emerging endosurgical interventions for treatment of obesity. In this statement, the ASMBS establishes its position on the appropriate steps to be taken before acceptance of new technologies for the treatment of obesity that are based on current knowledge, careful consideration of experts, and published peer-reviewed scientific evidence available at this time. The intent of issuing such a statement is to provide objective information about the process that should be followed in this exciting time of development for endosurgical interventions. The statement is not intended as, and should not be construed as, stating or establishing a local, regional, or national standard of care. The statement will be revised in the future as additional evidence becomes available.

Section snippets

Emerging endosurgical interventions for treatment of obesity position statement and standard of care

This Position Statement is not intended to provide inflexible rules or requirements of practice and is not intended, nor should it be used, to state or establish a local, regional, or national legal standard of care. Ultimately, there are various appropriate treatment modalities for each patient, and surgeons must use their judgment in selecting from among the different feasible treatment options.

The American Society for Metabolic and Bariatric Surgery cautions against the use of this Position

Disclosures

The author claims no commercial associations that might be a conflict of interest in relation to this article.

References (7)

A.M. Reitsma et al.
Ethical regulations for innovative surgery: the last frontier?
J Am Coll Surg
(2002)
A.M. Reitsma et al.
Ethics of innovative surgery: US surgeons' definitions, knowledge, and attitudes
J Am Coll Surg
(2005)
H. Buchwald
Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers
Surg Obes Relat Dis
(2005)

There are more references available in the full text version of this article.

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La cirugía bariátrica es el tratamiento más efectivo para tratar la obesidad y sus comorbilidades, sin embargo, hay barreras que evitan que estas sean aceptadas de forma generalizada. Ante la creciente epidemia de obesidad, surge la necesidad de crear nuevos tratamientos menos invasivos, los cuales deben tener un amplio margen de seguridad y efectividad para condicionar pérdida de peso, al menos mayor que un tratamiento basado en dieta y ejercicio. Estos incluyen dispositivos que se colocan y retiran por endoscopía y se clasifican en: dispositivos ocupativos, procedimientos restrictivos o remodelantes de la anatomía, bypass endoluminal y remodelación duodenal. También se dispone de técnicas percutáneas y de cirugías «menos» invasivas.
En general, los resultados obtenidos muestran mejoría en el metabolismo de la glucosa de los pacientes diabéticos y en cuanto a la pérdida de peso, aunque no superan a la cirugía bariátrica, se observan resultados que tienen mayor alcance si se comparan con el tratamiento conservador (dieta y ejercicio). La tasa de eventos adversos es baja. El uso clínico de una nueva tecnología debe practicarse dentro de un programa de manejo multidisciplinario que incluya soporte nutricional, psicológico, deportivo, y médico. Es de suma importancia reconocer que estas terapias no son creadas para sustituir a la cirugía bariátrica, sino para aumentar las opciones de tratamientos y generar mayor alcance e impacto en la población general. Este trabajo tiene por objeto una revisión actualizada de la literatura sobre tecnologías emergentes para el tratamiento de la obesidad.
Bariatric surgery is the most effective treatment for obesity and its comorbidities but there are barriers that prevent its general acceptance. The growing obesity epidemic has resulted in the need for the creation of new, less invasive treatments, with a wide margin of safety and effectiveness for conditioning weight loss, at least greater than that resulting from treatment based on diet and exercise. Emerging therapies include devices that are endoscopically placed and removed, classified as: space-occupying devices, restrictive or anatomic-remodeling procedures, endoluminal bypass, and duodenal mucosal resurfacing. Percutaneous techniques and less invasive surgeries are also included.
In general, results have shown improvement in glucose metabolism in diabetic patients. With respect to weight loss, results do not surpass those of bariatric surgery, but are better than results with conservative treatment (diet and exercise) and have a low rate of adverse events. Clinical use of a new technique should be carried out within a multidisciplinary management program that includes nutritional, psychologic, physical activity, and medical support. It must be understood that novel therapies are not being created to substitute bariatric surgery, but rather to increase treatment options in the general population, with greater reach and impact. The aim of the present study was to provide an up-to-date literature review on emerging technologies for the treatment of obesity.
Cross-talk between bile acids and gastro-intestinal and thermogenic hormones: Clues from bariatric surgery
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Citation Excerpt :
Other sources indicate that “bar-iatric” comes from two words of the modern Greek baros and iatrikos, meaning “load” and “medicine”, respectively.83 The National Institute of Health (NIH) issued the initial indications for bariatric surgery in 1991, and more recently, the European Association for Endoscopic Surgery (EAES), and the American Society for Metabolic and Bariat-ric Surgery (ASBS) added novel indications and recommended bariatric surgery also for subjects displaying mild obesity (Class 1) associated with severe comorbidities including T2DM.84,85 Category of patients and procedures should be chosen depending on local availability, selection criteria, and surgeon’s experience (Table 2).
Obesity is rapidly increasing and has reached epidemic features worldwide. Obesity is linked to insulin resistance, systemic low-grade inflammation and common pathogenic pathways with a number of comorbidities (including cancer), leading to high mortality rates. Besides change of lifestyles (diet and physical exercise) and pharmacological therapy, bariatric surgery is able to rapidly improve several metabolic and morphologic features associated with excessive fat storage, and currently represents an in vivo model to study the pathogenic mechanisms underlying obesity and obesity-related complications. Studies on obese subjects undergoing bariatric surgery find that the effects of surgery are not simply secondary to gastric mechanical restriction and malabsorption which induce body weight loss. In fact, some surgical procedures positively modify key pathways involving the intestine, bile acids, receptor signaling, gut microbiota, hormones and thermogenesis, leading to systemic metabolic changes. Furthermore, bariatric surgery represents a suitable model to evaluate the gene-environment interaction and some epigenetic mechanisms linking obesity and insulin resistance to metabolic diseases.
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Thus, objective evaluation of new techniques through Institutional Review Board–mediated research, in addition to regimented training programs for physicians, is necessary to allow for proper evaluation of the safety and efficacy of these procedures and the technical performance of them. The American Society for Metabolic and Bariatric Surgery,1 the Society of American Gastrointestinal and Endoscopic Surgeons,2 and, more recently, the American Society for Gastrointestinal Endoscopy (ASGE)3 have written position statements focused on these new procedures. In this way, proper indications, expected outcomes, and, most importantly, safety standards and contraindications can be developed and maintained.
A pathway to endoscopic bariatric therapies: ASGE/ASMBS task force on endoscopic bariatric therapy
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EBT should also be performed in this context in order to achieve maximal benefit. Nutritional support, experienced nursing care, behavioral medicine specialists, and physicians experienced in the management of obese patients, are essential components of such programs [91]. In addition, the ability and availability of physicians and surgeons willing and able to manage potential complications in obese patients is advised.
The American Society for Gastrointestinal Endoscopy (ASGE) is dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. The American Society for Metabolic and Bariatric Surgery (ASMBS) is dedicated to improving public health and well-being by lessening the burden of the disease of obesity and related diseases. They are the largest professional societies for their respective specialties of gastrointestinal endoscopy and bariatric surgery in the world. The ASGE/ASMBS task force was developed to collaboratively address opportunities for endoscopic approaches to obesity, reflecting the strengths of our disciplines, to improve patient and societal outcomes. This white paper is intended to provide a framework for, and a pathway towards, the development, investigation, and adoption of safe and effective endoscopic bariatric therapies (EBT).
A pathway to endoscopic bariatric therapies
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Citation Excerpt :
EBT should also be performed in this context in order to achieve maximal benefit. Nutritional support, experienced nursing care, behavioral medicine specialists, and physicians experienced in the management of obese patients, are essential components of such programs.91 In addition, the ability and availability of physicians and surgeons willing and able to manage potential complications in obese patients is advised.
A Curious Case of a Staple Line Leak Presenting 18 Months After Sleeve Gastrectomy: Our Management Approach
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: Reprint requests: Eric J. DeMaria, MD, Chair, ASMBS Clinical Issues Committee, American Society for Metabolic and Bariatric Surgery, 100 Southwest 75th Street, Suite 201, Gainesville, FL 32607

: E-mail: [email protected]

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UpdateAmerican Society for Metabolic and Bariatric Surgery Position Statement on emerging endosurgical interventions for treatment of obesity

Abstract

Section snippets

Emerging endosurgical interventions for treatment of obesity position statement and standard of care

Disclosures

J Am Coll Surg

J Am Coll Surg

Surg Obes Relat Dis

Update
American Society for Metabolic and Bariatric Surgery Position Statement on emerging endosurgical interventions for treatment of obesity