Endoscopic therapy for obesity and complications of bariatric surgery

Size: px
Start display at page:

Download "Endoscopic therapy for obesity and complications of bariatric surgery"

Transcription

1 Endoscopic therapy for obesity and complications of bariatric surgery Jacques Devière, MD, PhD Erasme University Hospital Brussels Belgium

2 Obesity Affects 300 millions people worldwide (WHO) Is linked to deaths/year in western countries 100 billions dollars direct healthcare expenditures/year in USA (where 22 millions adults are MORBIDLY obese) Incidence (and indications for treatment) increased by 800% over the last 15 years Lancet 2005;366:1197, NEJM 2007;356:21

3 Complications of bariatric surgery Cardiopulmonary insufficiency. Anastomotic fistula. Wound infections. Digestive occlusions. Bleeding. Incisional hernias. Migration of implanted material. Having an effective procedure which does not require transabdominal access would be appealing

4 Balloon implantation

5 Bioenterics BIB 10 series, 900 patients, mainly retrospective, rare controlled series Major indications Before surgery for superobese Non morbid obesity (BMI < 40) 6 months treatment Results : Median Excess Weight Loss around 30%, Median BMI loss 5 kg/m2

6 Transoral vertical gastroplasty in 64 patients Fogel et al, GIE 2008 ; 68 : Endocinch suture.

7 Transoral vertical gastroplasty in 64 patients Fogel et al, GIE 2008 ; 68 : % EWL 12 months = 58% Too beautiful to be true? Bessler, GIE 2008 ; 68 : 59-60

8 Transoral gastroplasty (TOGa) Deviere et al Surg Endosc 2008, Moreno et al Endoscopy 2008 Video Forum Nishi GK et al, 1016

9

10

11

12

13 Main results of the first human pilot trial Average BMI decreased from 43.3 pretreatment to 38.6 at 6 months (p<0.0001) Absolute mean weight loss was 8 kgs, 11.1 kgs and 13 kgs at 1, 3 and 6 months, respectively Mean excess weight loss was 16%, 22% and 24.4% at 1, 3 and 6 months, respectively Mid stomas were observed between the 2 staple lines in 9/21 patients Deviere et al, Surg Endosc 2008; 22: 589

14 Adjustable septum TOGA Pilot Trial Phase II 1 and 2 sleeves

15 TOGA Pilot Trial Phase II : Weight Loss TOGA N Engl J Med 2007;357:741-52

16 TOGa, Balloon and 3 Surgical techniques in a single bariatric center : Absolute Weight loss Poids (Kg) mois 3 mois 6 mois 9 mois 12 mois 18 mois 24 mois Banding Bypass SRVG BIG TOGa1 TOGa2

17 Prospective randomized study 11 centers, 10 US, 1 Europe Sham-controlled, 2:1 303 patients, inclusion completed 1 perforation due to wire looping

18 RYGBP after TOGa 4 patients, after 1 year follow up Stapling visible in 3/4 Mean operative time 112 minutes vs 110 min for the last 10 primary RYGBP and 142 min for the last 10 RYGBP after restrictive surgery by the same operator Closset et al, Obes Surg, ip

19

20 Implantable Devices EndoBarrier (GIDynamics) Pilot clinical results: weight loss and improvement of diabetes Others: Barosense, ValenTx

21 Endoscopic treatment of GI complications after bariatric surgery Dilatation of anastomotic/ post gastroplasty stenoses Removal of partially migrated Rings and Lapbands Treatment of leakages/ fistulae

22 Strictures Etiology: Ischemia, Ulceration (RYGBP), Band related (LapBand, Gastroplasty) Treatment: Dilatation, starting mm.. in RYGBP.. Band Removal... Surgical Revision

23

24

25

26

27

28

29

30

31

32

33

34

35 Various cases.. Ring or band dysfunction type I. Slipping II. Stenosis with pouch dilation IIIa. Minor Erosion IIIb. Major Erosion or intragastric migration Symptoms Weight gain, reflux or obstruction Nausea, vomiting, weight loss Weight gain, abdominal pain (port-site infection) Weight gain, abdominal pain Diagnosis Contrast RX Contrast RX/ Endoscopy UGI Endoscopy UGI Endoscopy

36 Technique, success and complications Case n Dysfunction type SEPS placement Band or ring cutting Endoscopic success 1 II + + Yes No 2 II + - Yes No 3 II + - Yes No 4 II + - Yes No 5 IIIa + + Yes No 6 IIIa + + Yes No 7 IIIa + - Yes No 8 II + - Yes No 9 IIIb - + Yes No 10 IIIa + + Yes No 11 IIIb - + No Failure 12 II - + Yes No 13 II + - Yes No Complication Blero et al, GIE, submitted

37 Leakages/fistulae: Surgical principles 1. Control of leakage 2. Clearance of mediastinal or peritoneal contamination/collections by lavage & drainage 3. Antibiotics 4. Nutritional support TO BE FOLLOWED WHEN ENDOSCOPIC TREATMENT IS FORESEEN!

38 Clips/Sutures do not work Early diagnosis (hours) Delayed diagnosis (days) Chronic situation (weeks) Leak/Fistula Abcess / Collection Primary repair - + +/

39 GIE 1996;44:477

40 Treatment of post operative fistulae after bariatric surgery : 21 pts Type of fistula Gastro-Cutaneous/Per 18 Duodeno-Cutaneous 2 Gastro-Bronchial 1 Revision laparoscopies None 5 One 11 Two 5 Median delay between laparoscopic bariatric surgery and endotherapy (days) 30 (21-199) Endoscopy 2007; 39:625

41 Sequencial Endotherapy 1. SEMS (Ultraflex) in order to cover the fistula ( 2-3 months)

42 Sequencial Endotherapy SEPS (Polyflex) to remove both stents (pressure induced necrosis, days)

43 PROXIMAL DISTAL HYPERPLASIA AFTER ULTRAFLEX 2 months by after radial placement forces RETRIEVAL PLASTIC AFTER STENT POLYFLEX TO INDUCE RETRIEVAL NECROSIS (15 days OF HYPERPLASIA in place) Major Major disappearence disappearence of of proximal distal hyperplasia Proximal part hyperplasia

44 Success (Complete fistula healing after stent removal with > 2mo f-up) Primary (1 stenting period: 13/21pts) Complementary stenting plus sealant (4/8 residual pts) Success with endoscopic treatment: 17/21 pts (81 %) Endoscopy 2007; 39:625

45 For refractory fistulae Fistula Plug Surgisis Submucosal intestinal preparation (pig) Allows fibroblastic migration and enhance healing of anal fistulae

46 Fistula Plug implantation

47 Results of Fistula Plug use in chronic fistulae 10 patients with cutaneous fistulae refractory to previous surgical/endoscopic treatments 1 to 3 Plugs inserted according to fistula diameter Covered by a stent 60 % of patients healed with a median follow-up of 7 months Toussaint et al, Endoscopy, 2009

48 Collections / Abcesses after gastric bypass Voermans, GIE 2007; 66: 1013

49

50 Conclusions Endoscopic techniques may offer alternative approaches to obesity (Morbid, grade 1?, bridge to RYGBP) Endoscopy plays a growing role in managing complications of bariatric surgery A multidisciplinary approach and case volume are the cornerstone of an optimal management of these patients

Endoluminal Bariatric Revision. Todd David Wilson, MD

Endoluminal Bariatric Revision. Todd David Wilson, MD Endoluminal Bariatric Revision Todd David Wilson, MD Surgical Endoscopy and the Bariatric Surgeon Preoperative Endoscopy Postoperative Endoscopy Revisional Endoscopy Primary Endoluminal Bariatrics Preoperative

More information

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose Acute Abdominal Pain following Bariatric Surgery Kathy J. Morris, DNP, APRN, FNP C, FAANP University of Nebraska Medical Center College of Nursing Disclosure I have nothing to disclose Objectives Pathophysiology

More information

Emerging Concepts in Bariatric Surgery

Emerging Concepts in Bariatric Surgery Emerging Concepts in Bariatric Surgery C Y N T H I A L. L O N G, M D, F A C S S I N A I H O S P I T A L O F B A L T I M O R E D E P A R T M E N T O F S U R G E R Y D I V I S I O N O F M I N I M A L L Y

More information

Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center

Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center Endoscopic Management of Strictures and Leaks Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center What can go wrong? Bleeding (2%) Sleeve too big Angulated Too

More information

Types of Bariatric Procedures. Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012

Types of Bariatric Procedures. Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012 Types of Bariatric Procedures Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012 A Brief History of Bariatric Surgery First seen in pts with short bowel syndrome weight loss First

More information

11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation

11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation I have nothing to Disclose Ramsey Dallal, MD, FACS Vice Chair Department of Surgery Chief Bariatric i and Minimally i Invasive Surgery Einstein Healthcare Network Nemacolin, PA 2014 Covered Stents discussed

More information

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Authors: Chiranjiv S Virk, I Michael Leitman and Elliot R Goodman. Location: Beth Israel

More information

Emergencies in Post- Bariatric Surgery Patients

Emergencies in Post- Bariatric Surgery Patients Emergencies in Post- Patients Disclosures Dr. Birnbaumer has no financial disclosures Diane M. Birnbaumer, M.D., FACEP Professor of Medicine University of California, Los Angeles Senior Clinical Educator

More information

Valk J.W., Gypen B., Abdelgabar A., Hendrickx L. Schijns W., Aarts E., Janssen I., Berends F. Rheinwalt K.P., Schneider S., Plamper A.

Valk J.W., Gypen B., Abdelgabar A., Hendrickx L. Schijns W., Aarts E., Janssen I., Berends F. Rheinwalt K.P., Schneider S., Plamper A. Revisional Surgery for Weight Regain or Insufficient Weight Loss after Gastric Bypass using the Minimizer Ring: Short Term Results of a Multi Center Study Valk J.W., Gypen B., Abdelgabar A., Hendrickx

More information

23/06/2014. Objectives. Bariatric Patients. Endoscopic Management of Post Bariatric Surgery

23/06/2014. Objectives. Bariatric Patients. Endoscopic Management of Post Bariatric Surgery Endoscopic Management of Post Bariatric Surgery Greg Lutzak BSC, MD, FRCPC University of Alberta Royal Alexandra Hospital June 6, 2014 Objectives 1) Review common bariatric complications encountered in

More information

Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Abstract Background Methods:

Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Abstract Background Methods: Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Mousa Khoursheed, Ibtisam Al-Bader, Ali Mouzannar, Abdulla Al-Haddad, Ali Sayed, Ali Mohammad,

More information

Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients

Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients Surgery for Obesity and Related Diseases 6 (2010) 689 694 Video original article Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients Stacy A. Brethauer, M.D.

More information

Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of

Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of Surgery & Associate Residency Program Director UC Irvine

More information

5. Conversion Procedures that change from an index procedure to a different type of procedure.

5. Conversion Procedures that change from an index procedure to a different type of procedure. Benefit Coverage Covered Benefit for lines of business including Health Benefits Exchange (HBE), Rite Care (MED), Children with Special Needs (CSN), Substitute Care (SUB), Rhody Health Partners (RHP),

More information

Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it

Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it CENTER OF EXCELLENCE FOR THE STUDY AND OBESITY TREATMENT Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it Concepts and Results in a series of 11-years experience with 2,200 patients Miguel-A.

More information

Technical Aspects of Bariatric Surgical Procedures. Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital

Technical Aspects of Bariatric Surgical Procedures. Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital Technical Aspects of Bariatric Surgical Procedures Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital Disclosures Allergan, Inc. (Past) Faculty Member Educational

More information

Scott A. Shikora, MD, FACS. Sleeve Gastrectomy. Sleeve Gastrectomy. Sleeve Gastrectomy 11/8/2013

Scott A. Shikora, MD, FACS. Sleeve Gastrectomy. Sleeve Gastrectomy. Sleeve Gastrectomy 11/8/2013 DISCLOSURE Scott A. Shikora, MD, FACS Scott A. Shikora, MD, FACS Associate Professor of Surgery Harvard Medical School Director, Center for Metabolic and Bariatric Surgery Brigham and Women s Hospital

More information

Dept. of Medical Imaging University of Ottawa

Dept. of Medical Imaging University of Ottawa ED Visits Related to Bariatric Surgery: Review of Normal Post-Surgical Anatomy as Well as Complications Dept. of Medical Imaging University of Ottawa Disclosures Background Roux-en-Y Gastric Bypass Surgery

More information

Roux-en-y gastric bypass - clinical perspectives

Roux-en-y gastric bypass - clinical perspectives Roux-en-y gastric bypass - clinical perspectives Tom Mala Consultant surgeon Department of Gastroenterologic Surgery Oslo University Hospital Bariatric surgery weight loss Sjøstrøm L, JAMA 2012 Five-year

More information

Overview of Bariatric Surgery

Overview of Bariatric Surgery Overview of Bariatric Surgery To better understand how weight loss surgery works, it is helpful to know how the normal digestive process works. As food moves along the digestive tract, special digestive

More information

UW MEDICINE PATIENT EDUCATION. Weight Loss Surgery. What is bariatric surgery?

UW MEDICINE PATIENT EDUCATION. Weight Loss Surgery. What is bariatric surgery? UW MEDICINE PATIENT EDUCATION Weight Loss Surgery Divided proximal roux-y-gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. This section of the Guide to Your

More information

USE OF STENTS FOR UPPER GI DISASTERS. Michael Talbot. The St George Hospital, Sydney

USE OF STENTS FOR UPPER GI DISASTERS. Michael Talbot. The St George Hospital, Sydney USE OF STENTS FOR UPPER GI DISASTERS Michael Talbot. The St George Hospital, Sydney Disclosures Educational grants by Coviden, Applied Medical, Endogastric Solutions and Allergan in the last 3 years Clinical

More information

MH. Huang Show Chwan Memorial Hospital Changhua, Taïwan

MH. Huang Show Chwan Memorial Hospital Changhua, Taïwan PROGRAM ENDOLUMIINAL AND LAPAROSCOPIIC BARIIATRIIC AND METABOLIIC SURGERY COURSE SEPTEMBER 10 12,, 2015 CHHAAIIRRMMAANN MH. Huang Show Chwan Memorial Hospital Changhua, Taïwan PPRREESSIIDDEENNTT SSUUPPEERRIINNTTEENNDDEENNTT

More information

5/9/2012. What is Morbid Obesity? Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 5 4 person)

5/9/2012. What is Morbid Obesity? Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 5 4 person) Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 5 4 person) 1990 1998 The Bariatric and Metabolic Center of Colorado Bariatric Surgery: Options, Care

More information

When, Why, and How to Revise a Failed Sleeve Gastrectomy

When, Why, and How to Revise a Failed Sleeve Gastrectomy When, Why, and How to Revise a Failed Sleeve Gastrectomy Jin S. Yoo M.D. Assistant Professor of Surgery Duke University Medical Center April 6, 2013 When and Why Already Covered Let s Talk About How Overview

More information

Laparoscopic Revisional Gastric Bypass after open bariatric surgeries. Haider Alshurafa 1

Laparoscopic Revisional Gastric Bypass after open bariatric surgeries. Haider Alshurafa 1 Laparoscopic Revisional Gastric Bypass after open bariatric surgeries 1 Surgery Department, Riyadh Military Hospital, Riyadh, Saudi Arabia Haider Alshurafa 1 Objective: To confirm the feasibility of the

More information

Roux-en-Y Gastric Bypass

Roux-en-Y Gastric Bypass Roux-en-Y Gastric Bypass Restrictive and malabsorptive procedure Most frequently performed bariatric procedure in the US First done in 1967 Laparoscopic since 1993 75% EWL in 18-24 months 50% EWL is still

More information

Weight Loss before Hernia Repair Surgery

Weight Loss before Hernia Repair Surgery Weight Loss before Hernia Repair Surgery What is an abdominal wall hernia? The abdomen (commonly called the belly) holds many of your internal organs. In the front, the abdomen is protected by a tough

More information

Treatment for Severely Obese Patients

Treatment for Severely Obese Patients Treatment for Severely Obese Patients Associate Professor Jimmy So Senior Consultant Surgeon Director, Centre for Obesity Management and Surgery (COMS) National University Hospital Obesity Shortens Lives

More information

The GaBP Ring for Banding the Pouch in Gastric Bypass and Sleeve Gastrectomy Operations BARIATEC.COM

The GaBP Ring for Banding the Pouch in Gastric Bypass and Sleeve Gastrectomy Operations BARIATEC.COM The GaBP Ring for Banding the Pouch in Gastric Bypass and Sleeve Gastrectomy Operations BARIATEC.COM GaBP Ring The GaBP Ring is a prefabricated, caliberated and sterilized silicone coated implantable device

More information

What is the Sleeve Gastrectomy?

What is the Sleeve Gastrectomy? What is the Sleeve Gastrectomy? The Sleeve Gastrectomy (also referred to as the Gastric Sleeve, Vertical Sleeve Gastrectomy, Partial Gastrectomy, or Tube Gastrectomy) is a relatively new procedure for

More information

Surgical Weight Loss. Mission Bariatrics

Surgical Weight Loss. Mission Bariatrics Surgical Weight Loss Mission Bariatrics Obesity is a major health problem in the United States, with more than one in every three people suffering from this chronic condition. Obese adults are at an increased

More information

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS As a patient you must be adequately informed about your condition and the recommended surgical procedure. Please read this document carefully and ask about anything you do not understand. Please initial

More information

ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY

ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY Pre-operative medical assessment, post-operative follow-up and clinical outcome in bariatric surgery patients A. Thorell (SE) Nutrition

More information

The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx:

The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: James Cromie The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: INEFFECTIVE and UNSUSTAINED Bariatric surgery is an Effective and Durable treatment option Well established

More information

MEDICAL COVERAGE POLICY. SERVICE: Bariatric (Weight Loss) Surgery Policy Number: 053 Effective Date: 5/27/2014 Last Review: 4/24/2014

MEDICAL COVERAGE POLICY. SERVICE: Bariatric (Weight Loss) Surgery Policy Number: 053 Effective Date: 5/27/2014 Last Review: 4/24/2014 Page 1 of 6 MEDICAL COVERAGE POLICY Important note Even though this policy may indicate that a particular service or supply is considered covered, this conclusion is not necessarily based upon the terms

More information

Weight loss surgery more than just a gastric band

Weight loss surgery more than just a gastric band Weight loss surgery more than just a gastric band Presented by Ms Beth Murgatroyd Honorary Bariatric Nurse Practitioner Mr Ameet G Patel Consultant Surgeon Director of Bariatric Surgery at King s College

More information

Why the band in the Gastric Bypass Operation.

Why the band in the Gastric Bypass Operation. Center for Surgical Treatment of Obesity, Los Angeles, California C.S.T.O. Why the band in the Gastric Bypass Operation. M.A.L. Fobi, MD F.A.C.S. H. Lee, MD; B. Felahy, MD; N. Fobi, MD; P. Ako, MD Chi

More information

The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass

The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass ORIGINAL ARTICLE Annals of Gastroenterology (2015) 28, 1-6 The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass Katherine Arndtz a, Helen Steed b, James Hodson

More information

Bariatric Surgery: What the Internist Needs to Know

Bariatric Surgery: What the Internist Needs to Know Bariatric Surgery: What the Internist Needs to Know Richard Stahl, MD, FACS Assistant Professor of Surgery Medical Director of Bariatric Surgery Disclosures None (sadly) Objectives Describe several myths

More information

Obesity Epidemic - Costs

Obesity Epidemic - Costs What Clinicians should know about Bariatric Surgery Complications Dmitry Nepomnayshy MD Center for Surgical Weight Loss Lahey Clinic Disclosure None Thank Dr. Brams and Dr. Scheiry 1 Obesity Epidemic -

More information

Gastric Surgery for Clinically Severe (Morbid) Obesity

Gastric Surgery for Clinically Severe (Morbid) Obesity Origination: 03/28/01 Revised: 01/16/15 Annual Review: 11/12/15 Purpose: The Medical Technology Assessment Committee will review published scientific literature and information from appropriate government

More information

d EFFECTIVE DATE: 11 5 2014 POLICY LAST UPDATED: 5 29 2015

d EFFECTIVE DATE: 11 5 2014 POLICY LAST UPDATED: 5 29 2015 Medical Coverage Policy Bariatric Surgery-Not medically necessary procedures d EFFECTIVE DATE: 11 5 2014 POLICY LAST UPDATED: 5 29 2015 OVERVIEW Surgery for obesity, termed bariatric surgery, is a treatment

More information

Band Erosion Following Gastric Banding: How to Treat It

Band Erosion Following Gastric Banding: How to Treat It Obesity Surgery, 17, 329-333 Band Erosion Following Gastric Banding: How to Treat It Ezio Lattuada, MD 1 ; Marco Antonio Zappa, MD 1 ; Enrico Mozzi, MD 1,2 ; Giuseppe Fichera, MD 1,2 ; Paola Granelli,

More information

Informed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name

Informed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name Informed Consent for Laparoscopic Roux en Y Gastric Bypass Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Roux en Y Gastric

More information

Surgical Treatment. Type II Diabetes in. Obesity. for. Mathew Rawlins, MD FACS Rockwood Bariatric Specialists

Surgical Treatment. Type II Diabetes in. Obesity. for. Mathew Rawlins, MD FACS Rockwood Bariatric Specialists Surgical Treatment for Type II Diabetes in Obesity Mathew Rawlins, MD FACS Rockwood Bariatric Specialists Co-Morbidities of Obesity Coronary Disease Hypertension Dyslipidemias Pulmonary insufficiency

More information

Endoluminal and Laparoscopic Bariatric & Metabolic Surgery Advanced Course

Endoluminal and Laparoscopic Bariatric & Metabolic Surgery Advanced Course Endoluminal and Laparoscopic Bariatric & Metabolic Surgery Advanced Course Directors of the course: Jacques MARESCAUX Michel VIX Manoel GALVAO NETO Silvana PERRETTA France France Brazil Italy Faculty:

More information

Laparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds

Laparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Laparoscopic Repair of Incisional Hernia Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Overview Definition Advantages of Laparoscopic Repair Disadvantages of Open Repair

More information

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Vertical Sleeve

More information

Vertical Sleeve Gastrectomy (VSG) - Also known as Sleeve Gastrectomy, Vertical Gastrectomy

Vertical Sleeve Gastrectomy (VSG) - Also known as Sleeve Gastrectomy, Vertical Gastrectomy Vertical Sleeve Gastrectomy (VSG) - Also known as Sleeve Gastrectomy, Vertical Gastrectomy The Vertical Sleeve Gastrectomy procedure (also called Sleeve Gastrectomy, Vertical Gastrectomy, Greater Curvature

More information

2013 RN.ORG, S.A., RN.ORG, LLC

2013 RN.ORG, S.A., RN.ORG, LLC Obesity: Bariatric Surgical Options WWW.RN.ORG Reviewed September, 2013, Expires September, 2015 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2013 RN.ORG,

More information

Laparoscopic Adjustable Gastric Banding as a Type of Weight Loss

Laparoscopic Adjustable Gastric Banding as a Type of Weight Loss Laparoscopic Adjustable Gastric Banding as a Type of Weight Loss Abstract Obesity has become a global health crisis. Traditional treatments try to modify behavior in regard to diet and exercise. Laparoscopic

More information

IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201420 APRIL 29, 2014

IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201420 APRIL 29, 2014 IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201420 APRIL 29, 2014 IHCP to cover sleeve gastrectomy surgery The Indiana Health Coverage Programs (IHCP) covers bariatric surgery for individuals with

More information

Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes

Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes People with diabetes Losing excess weight will assist in the management of

More information

The first endoscopically-delivered device therapy for obese patients with type 2 diabetes

The first endoscopically-delivered device therapy for obese patients with type 2 diabetes DIABETES WEIGHT ENDOBARRIER THERAPY The first endoscopically-delivered device therapy for obese patients with type 2 diabetes Restore the metabolic health of your patients with EndoBarrier Therapy. Dual

More information

Why a loop and new approach makes sense!

Why a loop and new approach makes sense! IP: tomach Intestinal Pylorus paring urgery Why a loop and new approach makes sense! Mitchell Roslin, MD, FAC Chief of Bariatric and Metabolic urgery Lenox Hill Hospital Northern Westchester Hospital Center

More information

BRIGHAM AND WOMEN S HOSPITAL HARVARD MEDICAL SCHOOL

BRIGHAM AND WOMEN S HOSPITAL HARVARD MEDICAL SCHOOL BRIGHAM AND WOMEN S HOSPITAL HARVARD MEDICAL SCHOOL Bariatric Surgery Patient and Endoscopic Treatment Christopher Thompson MD, MSc, FACG, FASGE Director of Therapeutic Endoscopy Division i i of Gastroenterology

More information

Choices Around Bariatric Surgery

Choices Around Bariatric Surgery Choices Around Bariatric Surgery What should you know? Richard Stubbs MD FRCS FRACS Wakefield Obesity Clinic, Wellington 152 kg / BMI 59 74 kg / BMI 29 Indications (NIH Consensus Statement 1991) BMI >

More information

Bariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY

Bariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY Bariatric i Surgery: Optimalizing i Outcome Results Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende THE OBESE PATIENT : A CHALLENGE FOR ANAESTHESIA, Ostend,14/11/09 BARIATRIC SURGERY 50 s : First Reported

More information

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Preoperative drainage is always indicated in malignant CBD strictures PRO Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Background Jaundice is associated with high perioperative morbidity

More information

Demographics. MBSAQIP Case Number: IDN: ACS NSQIP Case Number:

Demographics. MBSAQIP Case Number: IDN: ACS NSQIP Case Number: Demographics *LMRN: *DOB: / / *Gender: Male Female *Race: White Native Hawaiian/Other Pacific Islander Black or African American Asian American Indian or Alaska Native Unknown *Hispanic Ethnicity: Unknown

More information

BARIATRIC SURGERY AND OTHER INVASIVE TREATMENTS FOR OBESITY

BARIATRIC SURGERY AND OTHER INVASIVE TREATMENTS FOR OBESITY Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline must be read in its

More information

Morbid obesity is defined as a body mass index (BMI) >40 kg/m2 (normal BMI range: 19-25 kg/m2)

Morbid obesity is defined as a body mass index (BMI) >40 kg/m2 (normal BMI range: 19-25 kg/m2) Medical Policy Manual Topic: Bariatric Surgery Date of Origin: January 1996 Section: Surgery Last Reviewed Date: May 2016 Policy No: 58 Effective Date: June 1, 2016 IMPORTANT REMINDER Medical Policies

More information

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 WEIGHT LOSS SURGERY Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 EDUCATIONAL OBJECTIVES: Discuss the available pharmaceutical options for weight loss and risks of these medications Explain the

More information

Surgical Treatment of Obesity: A Surgeon s View

Surgical Treatment of Obesity: A Surgeon s View Surgical Treatment of Obesity: A Surgeon s View Jenny J. Choi, MD Director of Bariatrics Associate Director of Clinical Affairs Assistant Professor of Surgery Albert Einstein School of Medicine Montefiore

More information

Having a Gastric Band

Having a Gastric Band Having a Gastric Band Hope Building Upper G.I. / Bariatrics 0161 206 5062 All Rights Reserved 2014. Document for issue as handout. This booklet aims to describe: l What is a gastric band page 2 l How is

More information

Bariatric Weight Loss Surgery

Bariatric Weight Loss Surgery BARIATRIC SURGERY Bariatric Weight Loss Surgery The heart and science of medicine. Weight loss surgery, also known as bariatric surgery, was developed as a tool to help people with morbid obesity reduce

More information

US experience with the LAP-BAND system

US experience with the LAP-BAND system The American Journal of Surgery 184 (2002) 46S 50S US experience with the LAP-BAND system Christine J. Ren, M.D. a, *, Santiago Horgan, M.D. b, Jaime Ponce, M.D. c a New York University School of Medicine,

More information

Weight Loss Surgery Info for Physicians

Weight Loss Surgery Info for Physicians Weight Loss Surgery Info for Physicians As physicians, we see it every day when we see our patients more and more people are obese, and it s affecting their health. It s estimated that at least 2/3 of

More information

Obesity When to Recommend Surgery. Lily Chang, MD September 27, 2013

Obesity When to Recommend Surgery. Lily Chang, MD September 27, 2013 Obesity When to Recommend Surgery Lily Chang, MD September 27, 2013 Obesity BMI >30 Trends Among U.S. Adults Source: Behavioral Risk Factor Surveillance System, CDC, 2012 Obesity Related Co-Morbidities

More information

Novel treatments for complications after bariatric surgery

Novel treatments for complications after bariatric surgery DOI 10.1186/s13022-015-0021-2 REVIEW Open Access Novel treatments for complications after bariatric surgery Julián Hernández 1 and Camilo Boza 2* Abstract Bariatric surgery has been considered one of best

More information

en-y Y Gastric Bypass Types of Bariatric Surgery Gastric Bypass BARIATRIC SURGERY PROCEDURES Imaging the Gastric Bypass Patient

en-y Y Gastric Bypass Types of Bariatric Surgery Gastric Bypass BARIATRIC SURGERY PROCEDURES Imaging the Gastric Bypass Patient I have no financial disclosures Imaging the Gastric Bypass Patient Christine O. Menias, MD Associate Professor of Radiology Mallinckrodt Institute of Radiology Washington University St Louis, Missouri,

More information

Medical Coverage Policy Bariatric Surgery

Medical Coverage Policy Bariatric Surgery Medical Coverage Policy Bariatric Surgery Device/Equipment Drug Medical Surgery Test Other Effective Date: 9/1/2011 Policy Last Updated: 11/01/2011 Prospective review is recommended/required. Please check

More information

GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. www.carepointhealth.org GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. 201-795-8175 CarePointHealth.

GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. www.carepointhealth.org GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. 201-795-8175 CarePointHealth. www.carepointhealth.org GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS 201-795-8175 CarePointHealth.org 1 CONTENTS What is sleeve gastrectomy? Why choose sleeve gastrectomy? Health risks associated with excess

More information

Medical Policy Bariatric Surgery

Medical Policy Bariatric Surgery Medical Policy Bariatric Surgery Document Number: 001 Commercial MassHealth and Qualified Health Plans Authorization required X X Notification within 24 hours of service or next business day No notification

More information

BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS

BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS Thomas Rogula MD, Stacy Brethauer MD, Bipand Chand MD, and Philip Schauer, MD. "Gastric bypass surgery has become a popular option for obese

More information

The Evolution of Bariatric Surgery. History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics

The Evolution of Bariatric Surgery. History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics The Evolution of Bariatric Surgery History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics It s a BIG Problem & it s Getting Worse Obesity is now a disease

More information

The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery

The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery Program Overview The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery Weight Control and Metabolic Surgery Program The Weight Control and Metabolic

More information

Morbid obesity is defined as a body mass index (BMI) >40 kg/m2 (normal BMI range: 19-25 kg/m2)

Morbid obesity is defined as a body mass index (BMI) >40 kg/m2 (normal BMI range: 19-25 kg/m2) Medical Policy Manual Topic: Bariatric Surgery Date of Origin: January 1996 Section: Surgery Last Reviewed Date: August 2015 Policy No: 58 Effective Date: September 1, 2015 IMPORTANT REMINDER Medical Policies

More information

Morbid obesity is defined as a body mass index (BMI) >40 kg/m2 (normal BMI range: 19-25 kg/m2)

Morbid obesity is defined as a body mass index (BMI) >40 kg/m2 (normal BMI range: 19-25 kg/m2) Medical Policy Manual Topic: Bariatric Surgery Date of Origin: January 1996 Section: Surgery Last Reviewed Date: January 2014 Policy No: 58 Effective Date: July 1, 2014 IMPORTANT REMINDER Medical Policies

More information

Consumer summary Laparoscopic adjustable gastric banding for the treatment of obesity (Update and re-appraisal)

Consumer summary Laparoscopic adjustable gastric banding for the treatment of obesity (Update and re-appraisal) ASERNIP S Australian Safety and Efficacy Register of New Interventional Procedures Surgical Consumer summary Laparoscopic adjustable gastric banding for the treatment of obesity (Update and re-appraisal)

More information

Contraindications: Malign or benign strictures in the upper part of esophagus close to the cricopharyngeal muscle.

Contraindications: Malign or benign strictures in the upper part of esophagus close to the cricopharyngeal muscle. Manufactured by: ELLA CS, s.r.o. Milady Horákové 504 500 06 Hradec Králové 6 Czech Republic Phone: +420 49 527 91 11 Fax: +420 49 526 56 55 E-mail: volenec@ellacs.cz Instructions for Use FerX-ELLA Esophageal

More information

Gastric Band Erosion in 63 Cases: Endoscopic Removal and Rebanding Evaluated

Gastric Band Erosion in 63 Cases: Endoscopic Removal and Rebanding Evaluated DOI 10.1007/s11695-011-0468-0 CLINICAL RESEARCH Gastric Band Erosion in 63 Cases: Endoscopic Removal and Rebanding Evaluated Jacob Chisholm & Normayah Kitan & James Toouli & Lilian Kow # Springer Science+Business

More information

Bariatric Surgery. Beth A. Ryder, MD FACS. Assistant Professor of Surgery The Miriam Hospital Warren Alpert Medical School of Brown University

Bariatric Surgery. Beth A. Ryder, MD FACS. Assistant Professor of Surgery The Miriam Hospital Warren Alpert Medical School of Brown University Bariatric Surgery Beth A. Ryder, MD FACS Assistant Professor of Surgery The Miriam Hospital Warren Alpert Medical School of Brown University April 30, 2013 Why surgery? Eligibility criteria Most commonly

More information

ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy. Case Series

ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy. Case Series ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy Case Series Summary of Cases: USER EXPERIENCE The ABThera OA NPT system was found by surgeons to be a convenient and effective

More information

Aaron B. House MD, PGY-5 University of Kentucky Department of General Surgery Grand Rounds October 23, 2013

Aaron B. House MD, PGY-5 University of Kentucky Department of General Surgery Grand Rounds October 23, 2013 Aaron B. House MD, PGY-5 University of Kentucky Department of General Surgery Grand Rounds October 23, 2013 Objectives Briefly illustrate the recent obesity trends in the U.S Give a brief history of bariatric

More information

Weight-Loss Surgery for Adults With Diabetes or Prediabetes Who Are at the Lower Levels of Obesity

Weight-Loss Surgery for Adults With Diabetes or Prediabetes Who Are at the Lower Levels of Obesity Weight-Loss Surgery for Adults With Diabetes or Prediabetes Who Are at the Lower Levels of Obesity A Review of the Research for Adults With a BMI Between 30 and 35 Is This Information Right for Me? If

More information

Obesity Affects Quality of Life

Obesity Affects Quality of Life Obesity Obesity is a serious health epidemic. Obesity is a condition characterized by excessive body fat, genetic and environmental factors. Obesity increases the likelihood of certain diseases and other

More information

IEHP UM Subcommittee Approved Authorization Guidelines Bariatric Surgery for Morbid Obesity

IEHP UM Subcommittee Approved Authorization Guidelines Bariatric Surgery for Morbid Obesity According to the National Institutes of Health (NIH) Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity, the risk for morbidity and mortality accompanying obesity increases

More information

Redo Banding After Band Erosion Advantages of the MiniMizer Extra Band Conclusion Approximately 67% of the patients suffering from erosion have sought revisional surgery. The choice of redo procedures

More information

GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. www.malleysurgical.com GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS

GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. www.malleysurgical.com GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS www.malleysurgical.com GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS 1 CONTENTS What is sleeve gastrectomy? Why choose sleeve gastrectomy? Health risks associated with excess

More information

Androscoggin Valley Hospital: A Bariatric Satellite Site of Catholic Medical Center Surgical Weight Loss Options For a Healthier Tomorrow

Androscoggin Valley Hospital: A Bariatric Satellite Site of Catholic Medical Center Surgical Weight Loss Options For a Healthier Tomorrow Androscoggin Valley Hospital: A Bariatric Satellite Site of Catholic Medical Center Surgical Weight Loss Options For a Healthier Tomorrow Connie Campbell MD Are you where you want to be? What is Obesity?

More information

White Paper: Treating Clinical Obesity: When is Bariatric Surgery or Bariatric Surgery Revision Medically Necessary?

White Paper: Treating Clinical Obesity: When is Bariatric Surgery or Bariatric Surgery Revision Medically Necessary? White Paper: Treating Clinical Obesity: When is Bariatric Surgery or Bariatric Surgery Revision Medically Necessary? For Health Plans, Medical Management Organizations and TPAs Introduction More than one

More information

"Inevitable weight regain: sleeve Gastrectomy and non -banded gastric bypass."

Inevitable weight regain: sleeve Gastrectomy and non -banded gastric bypass. "Inevitable weight regain: sleeve Gastrectomy and non -banded gastric bypass." MAL Fobi Medical Director Center for Surgical Treatment of Obesity Carson CA, USA IEF web meeting in January 6, 2014. DISCLOSURES

More information

Laparoscopic Surgery for Severe (Morbid) Obesity Patient Information from SAGES

Laparoscopic Surgery for Severe (Morbid) Obesity Patient Information from SAGES Laparoscopic Surgery for Severe (Morbid) Obesity Patient Information from SAGES Laparoscopic surgery for obesity is for people who are severely overweight. Laparoscopy involves using a specialized telescope

More information

Lose the Weight, Find your Life

Lose the Weight, Find your Life Bariatric Surgery: University of Iowa Lose the Weight, Find your Life Isaac Samuel, MD, FRCS, FACS Professor of Surgery Director, Bariatric Surgery 1 Present UI Bariatric Surgeons Jessica Smith, MD Peter

More information

MEDICAL POLICY No. 91595-R2 SURGICAL TREATMENT OF OBESITY

MEDICAL POLICY No. 91595-R2 SURGICAL TREATMENT OF OBESITY SURGICAL TREATMENT OF OBESITY Effective Date: October 1, 2015 Review Dates: 8/11, 12/11, 2/12, 2/13, 2/14, 11/14, 2/15 Date Of Origin: August 10, 2011 Status: Current Note: This medical policy does not

More information

INFORMED CONSENT FOR LAPAROSCOPIC GASTRIC SLEEVE SURGICAL PROCEDURE

INFORMED CONSENT FOR LAPAROSCOPIC GASTRIC SLEEVE SURGICAL PROCEDURE INFORMED CONSENT FOR LAPAROSCOPIC GASTRIC SLEEVE SURGICAL PROCEDURE It is very important to [insert physician, practice name] that you understand and consent to the treatment your doctor is rendering and

More information

Morbid obesity is a chronic condition that

Morbid obesity is a chronic condition that COSMETIC A Review of Bariatric Surgery Procedures Morbid obesity is a chronic condition that is extremely difficult to treat. In addition to unhealthy food choices and lifestyles, effective treatment for

More information

FAQ - Bariatric Surgery Coding from the ASMBS Insurance Committee

FAQ - Bariatric Surgery Coding from the ASMBS Insurance Committee FAQ - Bariatric Surgery Coding from the ASMBS Insurance Committee CPT and ICD-9 are dictated by payer policy guidelines. These codes are for reference only. Updated Jan 2012 Disclaimer: The coding, billing

More information