Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

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

Splitting, impulsivity, and intimate partnerships in young obese women seeking bariatric treatment

Jana Zmolikova,1,2 Dita Pichlerova,3 Petr Bob,1,4 Denisa Schückova,5 Jitka Herlesova,3 Petr Weiss6 1Department of Psychiatry, First Faculty of Medicine, Center for Neuropsychiatric Research of Traumatic Stress, Charles University, 2Department of Clinical Psychology, Na Homolce Hospital, 3OB Clinic, Prague, 4Faculty of Medicine, Central European Institute of Technology, Masaryk University, Brno, 5Iscare Clinical Centre, 6Institute of Sexology, First Faculty of Medicine, Charles University, Prague, Czech Republic Background: Splitting represents a defense mechanism that describes fragmentation of conscious experience that may occur in various psychopathological conditions. The purpose of this study was to examine the relationship of splitting with disturbed cognitive and affective functions related to impulsivity and intimate partnerships in a group of obese patients indicated for bariatric treatment and compare the results with other obese patients and patients with bulimia nervosa. Methods: In this clinical study, we assessed 102 young women. The sample was divided into three subgroups: obese women (N=30), obese women indicated for bariatric treatment (N=48), and patients with bulimia nervosa (N=24). The patients were assessed using Splitting Index and Barratt Impulsivity Scale, and selected information about their intimate partnership was documented for all the participants.Results: The main results of this study indicate significant differences in the relationship of splitting and impulsivity with difficulties in intimate partnerships. These differences discriminate obese patients indicated for bariatric treatment from other obese patients and patients with bulimia nervosa.Conclusion: These findings may have significant implications for treatment of the obese patients indicated for bariatric treatment and their presurgery psychological evaluations. Keywords: splitting, impulsivity, obesity, bulimia nervosa, bariatric treatmen

EAES rapid guideline: systematic review, network meta-analysis, CINeMA and GRADE assessment, and European consensus on bariatric surgery–extension 2022

none38Background: The European Association for Endoscopic Surgery Bariatric Guidelines Group identified a gap in bariatric surgery recommendations with a structured, contextualized consideration of multiple bariatric interventions. Objective: To provide evidence-informed, transparent and trustworthy recommendations on the use of sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, gastric plication, biliopancreatic diversion with duodenal switch, one anastomosis gastric bypass, and single anastomosis duodeno-ileal bypass with sleeve gastrectomy in patients with severe obesity and metabolic diseases. Only laparoscopic procedures in adults were considered. Methods: A European interdisciplinary panel including general surgeons, obesity physicians, anesthetists, a psychologist and a patient representative informed outcome importance and minimal important differences. We conducted a systematic review and frequentist fixed and random-effects network meta-analysis of randomized-controlled trials (RCTs) using the graph theory approach for each outcome. We calculated the odds ratio or the (standardized) mean differences with 95% confidence intervals for binary and continuous outcomes, respectively. We assessed the certainty of evidence using the CINeMA and GRADE methodologies. We considered the risk/benefit outcomes within a GRADE evidence to decision framework to arrive at recommendations, which were validated through an anonymous Delphi process of the panel. Results: We identified 43 records reporting on 24 RCTs. Most network information surrounded sleeve gastrectomy and Roux-en-Y gastric bypass. Under consideration of the certainty of the evidence and evidence to decision parameters, we suggest sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass over adjustable gastric banding, biliopancreatic diversion with duodenal switch and gastric plication for the management of severe obesity and associated metabolic diseases. One anastomosis gastric bypass and single anastomosis duodeno-ileal bypass with sleeve gastrectomy are suggested as alternatives, although evidence on benefits and harms, and specific selection criteria is limited compared to sleeve gastrectomy and Roux-en-Y gastric bypass. The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/Lpv2kE Conclusions: This rapid guideline provides evidence-informed, pertinent recommendations on the use of bariatric and metabolic surgery for the management of severe obesity and metabolic diseases. The guideline replaces relevant recommendations published in the EAES Bariatric Guidelines 2020.noneCarrano F.M.; Iossa A.; Di Lorenzo N.; Silecchia G.; Kontouli K.-M.; Mavridis D.; Alarcon I.; Felsenreich D.M.; Sanchez-Cordero S.; Di Vincenzo A.; Balague-Ponz M.C.; Batterham R.L.; Bouvy N.; Copaescu C.; Dicker D.; Fried M.; Godoroja D.; Goitein D.; Halford J.C.G.; Kalogridaki M.; De Luca M.; Morales-Conde S.; Prager G.; Pucci A.; Vilallonga R.; Zani I.; Vandvik P.O.; Antoniou S.A.; Agresta F.; Azran C.; Busetto L.; Buza M.; Prats B.G.; Herlesova J.; Piatto G.; Pruijssers S.; Rayman S.; Romano E.Carrano, F. M.; Iossa, A.; Di Lorenzo, N.; Silecchia, G.; Kontouli, K. -M.; Mavridis, D.; Alarcon, I.; Felsenreich, D. M.; Sanchez-Cordero, S.; Di Vincenzo, A.; Balague-Ponz, M. C.; Batterham, R. L.; Bouvy, N.; Copaescu, C.; Dicker, D.; Fried, M.; Godoroja, D.; Goitein, D.; Halford, J. C. G.; Kalogridaki, M.; De Luca, M.; Morales-Conde, S.; Prager, G.; Pucci, A.; Vilallonga, R.; Zani, I.; Vandvik, P. O.; Antoniou, S. A.; Agresta, F.; Azran, C.; Busetto, L.; Buza, M.; Prats, B. G.; Herlesova, J.; Piatto, G.; Pruijssers, S.; Rayman, S.; Romano, E