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Related Concept Videos

Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding01:15

Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding

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Enteral nutrition encompasses various methods of delivering nutrition directly to the gastrointestinal (GI) tract, bypassing traditional oral intake. It is particularly beneficial for patients who cannot eat by mouth but have a functioning digestive system. Key methods include nasointestinal feeding, gastrostomy, and jejunostomy, each suited to different clinical scenarios based on the patient's needs and condition.
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
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Patient Selection in One Anastomosis/Mini Gastric Bypass-an Expert Modified Delphi Consensus.

Mohammad Kermansaravi1, Chetan Parmar2, Sonja Chiappetta3

  • 1Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

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|June 15, 2022
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Summary

One anastomosis/mini gastric bypass (OAGB/MGB) is a suitable option for various patient groups, including those with high BMIs or weight regain. However, careful patient selection is crucial, especially for those with severe GERD or Barrett's metaplasia.

Keywords:
Bariatric surgeryMetabolic surgeryOAGB/MGBPatient selection

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Area of Science:

  • Bariatric Surgery
  • Metabolic Surgery
  • Gastroenterology

Background:

  • One anastomosis/mini gastric bypass (OAGB/MGB) is a widely performed obesity and metabolic procedure.
  • Key concerns include bile reflux, esophageal cancer, and malnutrition.
  • Clinical guidelines for patient selection in OAGB/MGB are needed.

Purpose of the Study:

  • To establish clinical guidelines for patient selection in OAGB/MGB.
  • To provide daily support for clinicians in making appropriate patient choices.
  • Based on an expert modified Delphi consensus.

Main Methods:

  • A committee of 57 bariatric surgeons from 24 countries developed 69 statements.
  • A modified Delphi consensus voting process was conducted in two rounds.
  • Consensus was defined as agreement among ≥70.0% of experts.

Main Results:

  • Consensus was reached on 56 statements.
  • High agreement (≥90.0%) supported OAGB/MGB for patients with BMI >50, 60, or 70 kg/m² as a one-stage procedure.
  • OAGB/MGB was also supported as a second-stage procedure after sleeve gastrectomy and for weight regain after restrictive procedures.
  • No consensus was reached for OAGB/MGB in cases of resistant Helicobacter pylori or GERD after restrictive procedures.
  • Disagreement consensus was achieved for patients with intestinal metaplasia, severe GERD (C, D), Barrett's metaplasia, and insulinoma.

Conclusions:

  • OAGB/MGB is suitable for elderly patients, those with lower BMIs (30-35 kg/m²) and metabolic issues, and those with BMIs >50 kg/m² as a one-stage procedure.
  • The procedure is safe for vegetarian and vegan patients.
  • OAGB/MGB may be suitable for large hiatal hernias but should be avoided in patients with grade C/D esophagitis or Barrett's metaplasia.