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

{"article_title":"EAES rapid guideline: systematic review, network meta-analysis, CINeMA and GRADE assessment, and European consensus on bariatric surgery-extension 2022.","author":"Carrano FM, Iossa A, Di Lorenzo N, Silecchia G, Kontouli KM, Mavridis D, Alar\u00e7on I, Felsenreich DM, Sanchez-Cordero S, Di Vincenzo A, Balagu\u00e9-Ponz MC, Batterham RL, Bouvy N, Copaescu C, Dicker D, Fried M, Godoroja D, Goitein D, Halford JCG, Kalogridaki M, De Luca M, Morales-Conde S, Prager G, Pucci A, Vilallonga R, Zani I, Vandvik PO, Antoniou SA","journal_title":"Surgical endoscopy","issn":"1432-2218","isbn":"","publication_date":"2022-03-01","volume":"36","issue":"3","first_page":"1709","page_count":"","accession_number":"35059839","doi":"","publisher":"Springer","doctype":"Journal Article","subjects":"Bariatric Surgery methods; Gastric Bypass methods; Laparoscopy methods; Obesity, Morbid surgery; Adult; Humans; Consensus; Gastrectomy methods; GRADE Approach; Motion Pictures; Network Meta-Analysis; Treatment Outcome","interest_area":["Gastroenterology"," Surgery"],"abstract":"Background: 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. \u00a9 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=35059839","isPdfLink":true,"isSAML":false,"an":"35059839","number_other":"","type_pub":"","issn_electronic":"1432-2218","languages":"English","language":"eng","date_entry":"","date_update":"","titleSource":"Surgical endoscopy [Surg Endosc] 2022 Mar; Vol. 36 (3), pp. 1709-1725. Date of Electronic Publication: 2022 Jan 20.","date_pub_cy":"","type_document":"","contract_publisher":"","authored_on":"2022-03-01","description":"Background: 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.<br \/>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.<br \/>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.<br \/>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.<br \/> (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=35059839&authtype=shib&custid=ns346513&group=main&profile=eds","no_of_pages":"","authored_by":"Carrano FM, Iossa A, Di Lorenzo N, Silecchia G, Kontouli KM, Mavridis D, Alar\u00e7on I, Felsenreich DM, Sanchez-Cordero S, Di Vincenzo A, Balagu\u00e9-Ponz MC, Batterham RL, Bouvy N, Copaescu C, Dicker D, Fried M, Godoroja D, Goitein D, Halford JCG, Kalogridaki M, De Luca M, Morales-Conde S, Prager G, Pucci A, Vilallonga R, Zani I, Vandvik PO, Antoniou SA","header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"35059839","RelevancyScore":"915","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"914.601135253906"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=35059839&authtype=shib&custid=ns346513&group=main&profile=eds","physicalDescription":{"Pagination":{"StartPage":"1709"}},"additionalInfo":{"Authored_By":"Carrano FM, Iossa A, Di Lorenzo N, Silecchia G, Kontouli KM, Mavridis D, Alar\u00e7on I, Felsenreich DM, Sanchez-Cordero S, Di Vincenzo A, Balagu\u00e9-Ponz MC, Batterham RL, Bouvy N, Copaescu C, Dicker D, Fried M, Godoroja D, Goitein D, Halford JCG, Kalogridaki M, De Luca M, Morales-Conde S, Prager G, Pucci A, Vilallonga R, Zani I, Vandvik PO, Antoniou SA","Corporate_Authors":"EAES Bariatric Surgery Guidelines Group","Journal_Info":"Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE","Publication_Type":"Journal Article; Meta-Analysis; Practice Guideline; Research Support, Non-U.S. Gov't; Systematic Review","Published_Date":"2022-03-01","Source":"Surgical endoscopy [Surg Endosc] 2022 Mar; Vol. 36 (3), pp. 1709-1725. Date of Electronic Publication: 2022 Jan 20.","Languages":"English","Electronic_ISSN":"1432-2218","MeSH_Terms":"Bariatric Surgery*\/methods , Gastric Bypass*\/methods , Laparoscopy*\/methods , Obesity, Morbid*\/surgery, Adult ; Humans ; Consensus ; Gastrectomy\/methods ; GRADE Approach ; Motion Pictures ; Network Meta-Analysis ; Treatment Outcome","Subjects":"Adult, Humans, Consensus, Gastrectomy methods, GRADE Approach, Motion Pictures, Network Meta-Analysis, Treatment Outcome, Bariatric Surgery methods, Gastric Bypass methods, Laparoscopy methods, Obesity, Morbid surgery","Title_Abbreviations":"Surgical endoscopy","Volume":"36"}}