ASMBS Gastric Sleeve Position Statement

ASMBS Updates Position Statement on Sleeve Gastrectomy

ASMBS Gastric Sleeve Policy StatementThe American Society For Metabolic And Bariatric Surgery (ASMBS) recently issued an Updated Position Statement on Laparoscopic Sleeve Gastrectomy as a Bariatric Procedure.

The ASMBS statement highlights the “substantial comparative and long-term data now published in the peer-reviewed literature demonstrating durable weight loss, improved medical comorbidities, long-term patient satisfaction, and improved quality of life after SG (Sleeve Gastrectomy).”

As a result, the ASMBS “recognizes sleeve gastrectomy as an acceptable option as a primary bariatric procedure and as a first stage procedure in high risk patients as part of a planned staged approach.”

This updated position statement, dated 10/28/2011, is the third position statement on sleeve gastrectomy issued by the ASMBS. The ASMBS says updated position statements are periodically necessary based on new data that emerges in the evolving field of bariatric surgery.

The ASMBS first issued a position statement on sleeve gastrectomy in 2007. It identified the procedure as a possible option for carefully selected patients, while noting the lack of evidence supporting sustained weight loss beyond three years. The position statement was then updated in 2009, in response to new data and increasing use of the procedure, to say the ASMBS has now “accepted sleeve gastrectomy as an approved bariatric surgical procedure, primarily because of its potential value as a first-stage operation for high-risk patients.”

Sleeve gastrectomy, or gastric sleeve, is one of the newest options for weight loss surgery.
The sleeve gastrectomy procedure surgically reduces the stomach to a thin, vertical sleeve that is about 15 percent of the original size of the stomach. With a smaller stomach, patients feel full faster and consume less food, resulting in a significant loss of excess weight.

The sleeve gastrectomy procedure does not involve the disadvantages associated with gastric bypass (intestinal rerouting, dumping syndrome, malnutrition) or laparoscopic adjustable gastric banding (involves a medical implant, requires periodic adjustments, slower rate of weight loss).

The benefits and risks associated with sleeve gastrectomy have been shown to lie somewhere between the two currently accepted types of weight loss surgery, laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band (LAGB).

Some of the observations seen in sleeve gastrectomy studies:

  • Risk of SG to fall between LAGB and RYGB; 30-day complication rates were 2.2% for SG, 3.6% for RYGB, and 0.9% for LAGB (Michigan Bariatric Surgery Collaborative)
  • Percentage of excess weight loss following SG at 1,2,3,4, and 5 years was 62.7%, 64.7%, 64.0%, 57.3%, and 60.0%, respectively (Data from 3rd International Summit for Sleeve Gastectomy)
  • Remission rates of type 2 diabetes have been reported between 60% and 80%
  • Quality of life significantly improves after SG
  • Most serious complications are staple line leaks and bleeding (occur in 1-3% of patients)
  • Tendency for some weight regain after SG, similar to RYGB

Overall, sleeve gastrectomy appears to be a safe and effective treatment for morbid obesity. All procedures have advantages as well as disadvantages and risks as well as benefits that must be considered by prospective patients.

The cost of sleeve gastrectomy is somewhere between the cost of gastric bypass and gastric banding, on average from $10,000 – $11,000 and upward. Some insurance companies cover the procedure – United Healthcare began in October 2009 and Aetna in April 2010 – but many other insurance companies still consider it investigational and do not cover it.

The procedure code for sleeve gastrectomy (CPT 43775) was only recently established by the American Medical Association (AMA) on January 1, 2010, following the request of the ASMBS and the Society for Alimentary Gastrointestinal and Endoscopic Surgery (SAGES). Insurers use procedure codes to identify surgical, medical, or diagnostic services and to determine coverage and reimbursement.

The Centers for Medicare and Medicaid Services (CMS) is currently considering a proposal to cover laparoscopic sleeve gastrectomy as a treatment for obesity for Medicare beneficiaries. The agency plans to review the evidence and issue a proposed decision by March 30, 2012, and to make a final decision by June 30, 2012.

The ASMBS encourages surgeons “to continue to prospectively collect and report outcome data in the peer-reviewed scientific literature.”

American Society for Metabolic & Bariatric Surgery (ASMBS)

The ASMBS is the largest organization for bariatric surgeons in the world. It is a nonprofit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with morbid obesity.

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