The European Association for Endoscopic Surgery (EAES): Clinical practice guidelines for bariatric surgery, 2020

Consensus On Bariatric Operative Procedures:

• Adjustable gastric banding poses a high reoperation rate – owing to complications or conversion to another bariatric procedure because of insufficient long-term weight loss.
• Sleeve gastrectomy may be preferred over adjustable gastric banding – enables more significant weight loss and resolution of metabolic comorbidities (Conditional recommendation).
• Sleeve gastrectomy may achieve greater short-term weight loss and improved type 2 diabetes (T2D) resolution compared to gastric plication> However, mid-term results show no significant differences, and long-term data on weight loss and metabolic effects are lacking.
• Routine staple line reinforcement in sleeve gastrectomy lacks sufficient evidence for reducing leak rates.
• Consider staple line reinforcement––buttress, glues, suturing, and clips––in sleeve gastrectomy to lower the risk of perioperative complications (Strong recommendation).
• Using a bougie size <36F, rather than ≥36F, for calibration in sleeve gastrectomy may be associated with greater mid-term weight loss (Conditional recommendation).
• A more extensive antral resection (2-3 cm from the pylorus vs. >5 cm antral preservation) may improve short-term weight loss without increasing post-operative complications – long-term data are lacking.
• Roux-en-Y gastric bypass (RYGB) is preferred over adjustable gastric banding – provides greater weight loss and remission of insulin resistance and T2D (Strong recommendation).
• RYGB achieves similar mid-term weight loss and metabolic outcomes as sleeve gastrectomy – long-term comparisons are unavailable.
• RYGB may be preferred for patients with severe gastroesophageal reflux or esophagitis (Conditional recommendation).
• No recommendation can be made between biliopancreatic diversion with duodenal switch (BPD/DS) and sleeve gastrectomy based on current evidence (Conditional recommendation).
• Mid-term weight loss outcomes show no difference between BPD/DS and RYGB, though BPD/DS is more effective for T2D remission. Long-term comparative data are lacking.
• Evidence-based criteria indicating revisional bariatric/metabolic surgery remain lacking. Clinical decisions should prevail while offering revisional bariatric/metabolic surgery –based on a complete multidisciplinary assessment as recommended for the primary procedure. 
• Every patient undergoing bariatric/metabolic surgery should receive close post-operative monitoring by a multidisciplinary team (Strong recommendation).

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