What are the ESPGHN guidelines on bariatric surgery in children and adolescents with obesity?

Updated: Feb 20, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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Answer

In 2015, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition released the following guidelines on bariatric surgery in children and adolescents: [42, 43]

  • Consider bariatric surgery in “carefully selected” patients with a body mass index (BMI) >40 kg/m2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD), or in those with a BMI > 50kg/m2 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.

  • The Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, 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 still need to be considered investigational.


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