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Year 2020 / Volume 112 / Number 6

Special Article

Main prophylactic measures in bariatric endoscopy. Spanish Expert Recommendations Guideline

491-500

Eduardo Espinet Coll, Román Turró Arau, Aitor Orive Calzada, Carlos Dolz Abadía, Amador García Ruiz de Gordejuela, Andrés Sánchez Yagüe, Javier Nebreda Durán, Manoel Galvao Neto, Gontrand López-Nava Breviere, Alfredo Mata Bilbao, Alfonso Alcalde Vargas, Ramón Abad Belando, Andrés José del Pozo-García, José Miguel Esteban López-Jamar, Jordi Pujol Gebelli, Antonio José Torres García, José Antonio Ramírez Felipe, Miguel Muñoz Navas,

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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Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
© 2020 The Spanish Journal of Gastroenterology