背景:这项针对国际肥胖管理专家的调查旨在就标准化定义达成共识,并确定代谢减肥手术(MBS)中的共识和非共识领域,以帮助制定肥胖管理的临床实践指南。
方法:由包括26名减肥外科医生在内的43名肥胖管理专家进行了一项包含136个陈述的三轮德尔菲调查,4位内窥镜医师,8位内分泌学家,2位营养学家,2名顾问,内科医生,一位横跨六大洲的儿科医生在汉堡举行了为期两天的会议,德国。为了减少偏见,投票是一致的,声明对投票的问题既不有利也不不利,或者在有利和不利之间均衡。共识被定义为≥70%的选民间协议。
结果:就所有15个基本定义和报告声明达成共识,包括最初的次优临床反应,基线重量,经常性的体重增加,转换,和翻修手术。关于有利于Roux-en-Y胃旁路手术的外科手术类型的95/121声明达成共识,袖状胃切除术,和内镜下套管胃成形术。袖状胃切除术单吻合十二指肠回肠造口术达成了中度共识,而对胃内球囊的作用则没有达成共识。MBS在65岁以上和18岁以下的患者中达成共识,BMI>50kg/m2,并伴有各种肥胖相关并发症,如2型糖尿病,肝脏,和肾脏疾病。
结论:在对43名多学科专家的调查中,就适用于整个医学界的标准化定义和报告标准达成共识.利用周到的多模式方法探索了一种治疗肥胖患者的算法。
BACKGROUND: This survey of international experts in obesity management was conducted to achieve
consensus on standardized definitions and to identify areas of
consensus and non-
consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice
guidelines for the management of obesity.
METHODS: A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable.
Consensus was defined as ≥ 70% inter-voter agreement.
RESULTS: Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m2, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease.
CONCLUSIONS: In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach.