Clinical Practice Guidelines of The European Association for Endoscopic Surgery (EAES) on Bariatric Surgery

A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists, and a patient representative, along with a sponsorship from EAES, has updated the previous guidelines on bariatric surgery:

Indication for bariatric surgery 

• Consider Laparoscopic bariatric surgery for patients with BMI ≥ 40 kg/m2 and for patients with BMI ≥ 35–40 kg/m2 but associated comorbidities that may improve with weight loss.
• Consider Laparoscopic bariatric/metabolic surgery for patients with ≥ BMI 30–35 kg/m2 and type 2 diabetes and/or arterial hypertension with poor control even after optimal medical therapy.

Preoperative workup 

• No recommendation for either routine H. pylori eradication or before bariatric surgery.
• Consider preoperative dietitian consultation for patients undergoing bariatric surgery.
• Consider esophagogastroscopy as a routine diagnostic test before bariatric surgery
• consider Psychological evaluation before bariatric surgery
• A previous diagnosis of binge eating or depression is not an absolute contraindication to surgery

Perioperative management 

• Consider screening for obstructive sleep apnea using the STOP-BANG criteria before bariatric surgery.
• Consider perioperative CPAP in patients with severe obstructive sleep apnea syndrome who are undergoing bariatric surgery.
• No recommendation for the dose and duration of pharmacological thromboprophylaxis in patients after bariatric surgery 
• An inferior vena cava filter is not recommended for thromboprophylaxis in patients undergoing bariatric surgery.
• No recommendation for either an ERAS protocol or standard care.
• Consider perioperative multimodal analgesia with minimal opioid usage in patients undergoing bariatric surgery.

Source: Di Lorenzo N, et al. Surg Endosc. 2020 Jun;34(6):2332-2358. doi: 10.1007/s00464-020-07555-y.