Sleeve Gastrectomy as a Stand alone Bariatric Procedure for Obesity: A Technology Assessment

Judith Walsh, MD, MPH

CTAF

Recommendations of Others

Blue Cross Blue Shield Association (BCBSA)

BCBSA Technology Evaluation Center has not conducted a technology assessment of sleeve gastrectomy.

Centers for Medicare and Medicaid Services (CMS)

CMS National Coverage Decision (NCD) for Bariatric Surgery for Treatment of Morbid Obesity (100.1) effective February 2009 notes that open and laparoscopic sleeve gastrectomy are among non-covered bariatric surgery procedures for all Medicare beneficiaries.

American Society for Metabolic and Bariatric Surgery (ASMBS)

An ASMBS physician representative attended the CTAF meeting to provide testimony. In November 2009 an Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure was published (Attachment 1). This ASMBS update is available at: https://www.asmbs.org/Newsite07/resources/Updated_Position_Statement_on_Sleeve_Gastrectomy.pdf

American Gastroenterological Association (AGA)

The AGA was invited to have a representative attend the meeting to provide testimony. The AGA has noted that they do not have an opinion on the use of this procedure.

Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

A SAGES representative attended the CTAF meeting to provide testimony..

National Institute for Health and Clinical Excellence (NICE)

Guidance published by NICE and updated periodically is available at: https://www.nice.org.uk/nicemedia/pdf/CG43NICEGuideline.pdf

Veterans Affairs/Department of Defense (VA/DoD)

In 2006 the VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity was published in 2006. It is available at: https://www.healthquality.va.gov/obesity/obe06_final1.pdf

1 2 3 4 5

Next Section

Abbreviations

CTAF, California Technology Assessment Forum; SG, Sleeve gastrectomy; VSG, Vertical sleeve gastrectomy; LSG, Laparoscopic sleeve gastrectomy; BMI, Body mass index; CDC, Centers for Disease Control and Prevention; SOS, Swedish Obese Subjects; HDL, High-density-lipoprotein; VBG, Vertical banded gastroplasty; LAGB or LGB, Laparoscopic adjustable gastric banding; JIB, bypass; BPD, Biliopancreatic diversion; DS, Duodenal switch; RYGB, Roux-en-Y gastric bypass; GERD, Gastroesophageal reflux disease; DARE, Database of Abstracts of Reviews of Effects; %EBWL, Percentage of excess body weight lost; PPI, Proton pump inhibitor; GE, Gastroesophageal

Cite this: Sleeve Gastrectomy as a Stand alone Bariatric Procedure for Obesity: A Technology Assessment - Medscape - Oct 13, 2010.

Table 1. Characteristics of the studies comparing laparascopic sleeve gastrectomy to other treatments
Study	Design	Arm	N	Age	BMI kg/m2	F/u months
Himpens, 2006³⁰	RCT	LSG GBand	40 40	40 36	39 37	36 months
Karamanakos, 2008⁴⁴	RCT	LRYGB LSG	16 16	37 30.6	46.6 45.1	12 months
O'Keefe, 2010⁵³	Non-random Retrospective analysis	RYGB GBand VSG	157 34 6	67.3 not reported by group	48.5 45.9 50.0	12 months
Lee, 2007³¹	Non-random Retrospective Analysis	VSG GBand RYGB DS	216 271 303 56	43 42 43 42	49 42 46 47	24 months
Strain, 2009⁵⁴	Prospective non-randomized	GB BPD/DS GBand VSG	101 49 41 30	44.3 43.9 39.8 41.9	44.3 53.2 46.7 61.4	19.1 27.5 21.4 16.7
Abbatini, 2010⁵⁵	Retrospective	Gband GB SG	24 16 20	49,3 53 46.6	43.7 47.4 51.6	36 months
Lakdawala,	Retrospective	SG LRYGB	50 50	38 42	46 45.2	12 months

Table 2. Outcomes of studies comparing laparoscopic sleeve gastrectomy to other surgical treatments
Study	Arm	Weight loss at 12 months	12 month Median decrease in BMI kg/m2	36 month median decrease in BMI kg/m2	BMI Kg/m2 at 12 months	%EWL at 12 months	% EWL at 36 months	Mean change in BMI kg/m2 (varying follow up)	%EWL at various lengths of follow-up	% with resolution Type 2 DM at 12 months	% with resolution of HTN at 12 months
Himpens, 2006³⁰	LSG GBand	26 kg 14 kg*	25 15.5 *	27.5 18*		58 41*	66 48*
Karamanakos, 2008⁴⁴	LRYGB LSG				31.5 28.9	60.5 69.7*	--
O'Keefe, 2010⁵³	RYGB GBand VSG				32.7 39.4 42.0	59.8 33.5 34.3	--
Lee, 2007³¹	VSG GBand RYGB DS	129 lb 58 lb 110 lb 120 lb	--	---	37 32 28 27	59 47 75 79	--
Strain, 2009⁵⁴	GB BPD/DS GBand SG	---	---	28 27 32 37*	---	---	---	15.6 24 7.5 18	70% 84% 38% 49%*
Abbatini, 2010⁵⁵	Gband GB SG									60.8% 81.2% 80.9	44% 72.2% 66.6%
Lakdawala, 2010⁵⁶	SG LRYGB				26.3 31	76.1 62.2				98% 100%	98% 100%

Statistically significant with a p value of at least at p<0.05
O'Keefe, Lee, Abbatini, and Lakdawala did not report statistically significant comparisons between surgical procedures.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.