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Espinet Coll E, Turró Arau R, Nebreda Durán J, Del Pozo-García AJ, Esteban López-Jamar JM, Dolz Abadía C, Galvao Neto M, Espinet Coll F. Bariatric endoscopy, care-curative medicine and legal conflicts. Spanish Bariatric Endoscopy Group (Gettemo-SEED) Positioning. Rev Esp Enferm Dig 2023; 115:652-653. [PMID: 36719345 DOI: 10.17235/reed.2023.9476/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Bariatric endoscopy treats obesity as a disease, in addition to its multiple associated comorbidities, so it should be considered in the "care-curative" field and not as "satisfying, voluntary or outcoming" medicine. Insufficient weight loss cases, or complications may occur. This, in parallel with the greater diffusion of these techniques, results an increase in the risk of complaints and judicial claims, which will presumably grow during next years. In this sense, we consider that all Bariatric Endoscopic Units working with medical-scientific rigor, must be able to be accredited and have legal support by the Scientific Societies. We propose to create a Medical-Legal Advisory Committee, composed of a medical team and a specialized law firm, which allows advising and guiding the endoscopist when incurring in a conflict.
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Affiliation(s)
| | - Román Turró Arau
- Aparato Digestivo. Endoscopia Digestiva-Bariátrica, Centro Médico Teknon
| | | | | | | | | | - Manoel Galvao Neto
- Endoscopia y Cirugía Bariátrica, Instituto EndoVitta y ABC Medical School, Sao Paulo, Brazil. Saims Medical College, Indor, Brasil
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Espinet Coll E, Del Pozo García AJ, Turró Arau R, Nebreda Durán J, Cortés Rizo X, Serrano Jiménez A, Escartí Usó MÁ, Muñoz Tornero M, Carral Martínez D, Bernabéu López J, Sierra Bernal C, Martínez-Ares D, Espinel Díez J, Marra-López Valenciano C, Sola Vera J, Sanchis Artero L, Domínguez Jiménez JL, Carreño Macián R, Juanmartiñena Fernández JF, Fernández Zulueta A, Consiglieri Alvarado C, Grecco E, Bezerra Silva L, Galvao Neto M. Spanish Intragastric Balloon Consensus Statement (SIBC): practical guidelines based on experience of over 20 000 cases. Rev Esp Enferm Dig 2023; 115:22-34. [PMID: 36426855 DOI: 10.17235/reed.2022.9322/2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND intragastric balloons (IGBs) are a minimally invasive, increasingly popular option for obesity treatment. However, there is only one worldwide guideline standardizing the technical aspects of the procedure (BIBC, SOARD 2018). OBJECTIVES to construct a practical guideline for IGB usage by reproducing and expanding the BIBC survey among the Spanish Bariatric Endoscopy Group (GETTEMO). METHODS a 140-question survey was submitted to all GETTEMO members. Twenty-one Spanish experienced endoscopists in IGBs answered back. Eight topics on patient selection, indications/contraindications, technique, multidisciplinary follow-up, results, safety, and financial/legal aspects were discussed. Consensus was defined as consensus ≥ 70 %. RESULTS overall data included 20 680 IGBs including 12 different models. Mean age was 42.0 years-old, 79.9 % were women, and the mean preoperative body mass index (BMI) was 34.05 kg/m². Indication in BMI > 25 kg/m², 10 absolute contraindications, and nutritional and medication measures at follow-up were settled. A mean %TBWL (total body weight loss) of 17.66 % ± 2.5 % was observed. Early removal rate due to intolerance was 3.62 %. Adverse event rate was 0.70 % and 6.37 % for major and minor complications with consensual management. A single case of mortality occurred. IGBs were placed in private health, prior contract, and with full and single payment at the beginning. Seven lawsuits (0.034 %) were received, all ran through civil proceeding, and with favorable final resolution. CONCLUSIONS this consensus based on more than 20 000 cases represents practical recommendations to perform IGB procedures. This experience shows that the device leads to satisfactory weight loss with a low rate of adverse events. Most results are reproducible compared to those obtained by the BIBC.
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Affiliation(s)
| | | | - Román Turró Arau
- Aparato Digestivo. Endoscopia Digestiva-Bariátrica, Hospital Teknon
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- Aparato Digestivo y Endoscopia, Instituto EndoVitta y ABC Medical School, Mário Covas State Hospital
| | | | - Manoel Galvao Neto
- Endoscopia y Cirugía Bariátrica, Instituto EndoVitta y ABC Medical School, Sao Paulo, Brazil. Saims Medical College, Brasil
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Espinet Coll E, Turró Arau R, Orive Calzada A, Dolz Abadía C, García Ruiz de Gordejuela A, Sánchez Yagüe A, Nebreda Durán J, Galvao Neto M, López-Nava Breviere G, Mata Bilbao A, Alcalde Vargas A, Abad Belando R, Del Pozo-García AJ, Esteban López-Jamar JM, Pujol Gebelli J, Torres García AJ, Ramírez Felipe JA, Muñoz Navas M. Main prophylactic measures in bariatric endoscopy. Spanish Expert Recommendations Guideline. Rev Esp Enferm Dig 2020; 112:491-500. [PMID: 32450708 DOI: 10.17235/reed.2020.6970/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bariatric endoscopy (BE) encompasses a number of techniques -some consolidated, some under development- aiming to contribute to the management of obese patients and their associated metabolic diseases as a complement to dietary and lifestyle changes. To date different intragastric balloon models, suture systems, aspiration methods, substance injections and both gastric and duodenal malabsorptive devices have been developed, as well as endoscopic procedures for the revision of bariatric surgery. Their ongoing evolution conditions a gradual increase in the quantity and quality of scientific evidence about their effectiveness and safety. Despite this, scientific evidence remains inadequate to establish strong grades of recommendation allowing a unified perspective on prophylaxis in BE. This dearth of data conditions leads, in daily practice, to frequently extrapolate the measures that are used in bariatric surgery (BS) and/or in general therapeutic endoscopy. In this respect, this special article is intended to reach a consensus on the most common prophylactic measures we should apply in BE. The methodological design of this document was developed while attempting to comply with the following 5 phases: Phase 1: delimitation and scope of objectives, according to the GRADE Clinical Guidelines. Phase 2: setup of the Clinical Guide-developing Group: national experts, members of the Grupo Español de Endoscopia Bariátrica (GETTEMO, SEED), SEPD, and SECO, selecting 2 authors for each section. Phase 3: clinical question form (PICO): patients, intervention, comparison, outcomes. Phase 4: literature assessment and synthesis. Search for evidence and elaboration of recommendations. Based on the Oxford Centre for Evidence-Based Medicine classification, most evidence in this article will correspond to level 5 (expert opinions without explicit critical appraisal) and grade of recommendation C (favorable yet inconclusive recommendation) or D (inconclusive or inconsistent studies). Phase 5: External review by experts. We hope that these basic preventive measures will be of interest for daily practice, and may help prevent medical and/or legal conflicts for the benefit of patients, physicians, and BE in general.
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Affiliation(s)
| | - Román Turró Arau
- Aparato Digestivo. Endoscopia Digestiva-Bariátrica, Hospital Quirón Teknon
| | | | | | | | | | | | - Manoel Galvao Neto
- Endoscopia y Cirugía Bariátrica, Instituto Endovitta. Universidad Internacional de Florida, Brasil
| | | | | | | | | | | | | | - Jordi Pujol Gebelli
- Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitari de Bellvitge, España
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Espinet Coll E, López-Nava Breviere G, Nebreda Durán J, Marra-López Valenciano C, Turró Arau R, Esteban López-Jamar JM, Muñoz-Navas M. Spanish consensus document on bariatric endoscopy. Part 2: specific endoscopic treatments. Rev Esp Enferm Dig 2019; 111:140-154. [PMID: 30654612 DOI: 10.17235/reed.2019.4922/2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the last years we have been witnessing a significant increase in the number and type of bariatric endoscopic techniques: we have different types of balloons, suture systems, injection of substances and malabsorptive prosthesis, etc. Also, some endoscopic revisional procedures for patients with weight regain after bariatric surgery have been incorporated. This makes it necessary to protocolize, position and regularize all these techniques, through a consensus that allows their clinical application with the maximum medical rigor and scientific evidence available.
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Espinet Coll E, López-Nava Breviere G, Nebreda Durán J, Marra-López Valenciano C, Turró Arau R, Esteban López-Jamar JM, Muñoz-Navas M. Spanish Consensus Document on Bariatric Endoscopy. Part 1. General considerations. Rev Esp Enferm Dig 2018; 110:386-399. [PMID: 29766736 DOI: 10.17235/reed.2018.4503/2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Obesity is a chronic multifactorial, incurable, recurrent, and progressive disease associated with significant physical and psychological complications, and considerable morbidity and mortality. For this reason, the assessment, management, and follow-up of obese patients should take place in the setting of a multidisciplinary unit equipped with adequate human and structural resources. Medical treatment using hygienic-dietary measures, while indispensable, may be insufficient, and surgery, which is reserved for severe or morbid obesity, is not exempt from complications neither is to the liking of many patients. In this context three situations may be considered where endoscopic treatment, used as a supplementary strategy with few complications, contributes to benefit obese patients: first, in a subgroup of patients with grade-II overweight or non-morbid obesity where medical therapy alone failed or needs supplementation. Second, in patients with morbid obesity when surgery is rejected, is contraindicated, or entails excessive risk. Finally, in patients with superobesity who need to lose weight before bariatric surgery in order to reduce surgery-related morbidity and mortality. In this regard, the Spanish Task Force on Bariatric Endoscopy (Grupo Español de Trabajo para el Tratamiento Endoscópico del Metabolismo y la Obesidad, GETTEMO) have developed this Consensus Document to serve as practical guidance for all professionals involved in the endoscopic management of obesity, and to facilitate establishing a minimum set of requirements for the proper functioning of a bariatric endoscopy unit.
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Espinet Coll E, Nebreda Durán J, López-Nava Breviere G, Ducóns García J, Rodríguez-Téllez M, Crespo García J, Marra-López Valenciano C. Multicenter study on the safety of bariatric endoscopy. Rev Esp Enferm Dig 2018; 109:350-357. [PMID: 28301947 DOI: 10.17235/reed.2017.4499/2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Bariatric endoscopy includes a series of specific techniques focused on the management of obese patients. As a quality criterion, safety as expressed by a minimal incidence of serious complications is required in addition to efficacy. METHODS A descriptive, retrospective, multicenter review of the experience recorded at seven hospitals included in the Grupo Español de Endoscopia Bariátrica (GETTEMO) in order to document the incidence, cause, and resolution (including legal consequences) of serious complications reported for each bariatric technique, and according to endoscopist expertise. RESULTS In all, 6,771 bariatric endoscopic procedures were collected, wherein 57 serious complications (0.84%) were identified. Balloons: Orbera®-Medsil®, 5/5,589; Spatz2® (older model): 44/225; Heliosphere®: 1/70; Obalon®: 0/107. Sutures: POSE®, 5/679; sleeve gastroplasty with Apollo® system: 0/55. Prostheses: Endobarrier®: 2/46. All complications were resolved with medical/endoscopic management except for five cases (0.07%) that required surgery. A single lawsuit occurred (esophageal perforation with Spatz2® balloon), which had a favorable outcome. There was no mortality, and apparently no differences were found according to endoscopist expertise level. CONCLUSIONS In our multicenter experience, bariatric endoscopy may be considered as a safe procedure (0.84% of serious complications in all). However, some devices may induce a higher proportion of complications, such as 19.55% for Spatz2® balloons (already replaced) or 4.34% for Endobarrier® sleeves (at the upper limit of accepted safety), although our experience with the latter is limited. All complications were resolved with conservative medical management, and only exceptionally required surgery (0.07%). No technique-related mortality was seen, and only one lawsuit occurred. Further evolutionary studies are required on the novel endoscopic techniques presently emerging to authenticate our results.
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Espinet Coll E, Nebreda Durán J, López-Nava Breviere G, Galvao Neto M, Gómez Valero JA, Bacchiddu S, Vila Lolo C, Díaz Galán P, Bautista-Castaño I, Juan-Creix Comamala A. Efficacy and safety of transoral outlet reduction via endoscopic suturing in patients with weight regain after a surgical Roux-en-Y gastric bypass. Rev Esp Enferm Dig 2018; 110:551-556. [DOI: 10.17235/reed.2018.5419/2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Espinet Coll E, Nebreda Durán J, López-Nava Breviere G. A new swallowable intragastric balloon (Elipse®). Coffee for everybody? The position of GETTEMO. Rev Esp Enferm Dig 2017; 110:65. [PMID: 29168642 DOI: 10.17235/reed.2017.5214/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recently, the Elipse® swallow balloon with spontaneous evacuation has been incorporated. GETTEMO wants to position defending innovations in endoscopic treatment of bariatric patients, including this new gastric balloon. Any bariatric endoscopic procedure must always be done within a suitable protocol and in a Multidisciplinary Unit. In order to ensure maximum safety and to be able to effectively solve potential complications, in most of the cases a prior endoscopy should be required to rule out complications, the balloon must be implanted (or supervised) by a bariatric endoscopist and it is necessary to have an Endoscopic Emergency Department.
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Nebreda Durán J, Espinet Coll E. GETTEMO position statement on bariatric endoscopic techniques as a voluntary medicine. Rev Esp Enferm Dig 2017; 109:875-876. [PMID: 29072080 DOI: 10.17235/reed.2017.5144/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Dear Editor, We would like to clarify certain points in the article by C. Dolz et al. entitled "Informed consent in digestive endoscopy - Patient information, endoscopist protection", more specifically regarding the section "Obesity treatments". First, we want to congratulate the authors for their highly relevant yearlong research of the medico-legal aspects of Spanish endoscopy and for sharing their knowledge with endoscopists on a national level. With regard to the endoscopic management of obesity, we consider that the informed consent process should be even more comprehensive than that with other endoscopic techniques. As the author highlighted, there is less experience in some of these techniques.
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