What are the ESPGHAN guidelines for bariatric surgery in children?

Updated: May 28, 2019
  • Author: Alan A Saber, MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

In January 2015, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published a position statement on bariatric surgery for severely obese children and adolescents, which provided the following guidelines [10] :

  • Consider bariatric surgery in "carefully selected" patients with a body mass index (BMI) higher than 40 kg/m 2 who have severe comorbidities (eg, nonalcoholic fatty liver disease [NAFLD]) or in those with a BMI higher than 50 kg/m 2 who have milder comorbidities
  • Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity, personal desire to undergo the procedure, previous attempts at weight loss, and ability to adhere to follow-up care
  • Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and sleeve gastrectomy are the most widely used procedures in pediatric obesity, but their use is associated with subsequent nutritional deficiencies; temporary intragastric devices could represent a better option for initial treatment in pediatric populations
  • Current evidence suggests that bariatric surgery can decrease the grade of steatosis, hepatic inflammation, and fibrosis in NAFLD
  • Uncomplicated NAFLD is not an indication for bariatric surgery
  • Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents, as long as appropriate long-term follow-up is provided
  • Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
  • Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults must still be considered investigational

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