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The first modified Delphi consensus statement on sleeve gastrectomy

Surgical Endoscopy
Kamal K. Mahawar, Islam Omar, Rishi Singhal, Sandeep Aggarwal, Mustafa Ismail Allouch, Salman K. Alsabah, Luigi Angrisani, Faruq Mohamed Badiuddin, Jose María Balibrea, Ahmad Bashir, Estuardo Behrens, Kiron Bhatia, Laurent Biertho, L. Ulas Biter, Jerome Dargent, Maurizio De Luca, Eric DeMaria, Mohamed Hayssam Elfawal, Martin Fried, Khaled A. Gawdat, Yitka Graham, Miguel F. Herrera, Jacques M. Himpens, Farah A. Hussain, Kazunori Kasama, David Kerrigan, Lilian Kow, Jon Kristinsson, Marina Kurian, Ronald Liem, Rami Edward Lutfi, Vinod Menon, Karl Miller, Patrick Noel, Oral Ospanov, Mahir M. Ozmen, Ralph Peterli, Jaime Ponce, Gerhard Prager, Arun Prasad, P. Praveen Raj, Nelson R. Rodriguez, Raul Rosenthal, Nasser Sakran, Jorge Nunes Santos, Asim Shabbir, Scott A. Shikora, Peter K. Small, Craig J. Taylor, Cunchuan Wang, Rudolf Alfred Weiner, Mariusz Wylezol, Wah Yang, Ali Aminian
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The online version of this article (https://​doi.​org/​10.​1007/​s00464-020-08216-w) contains supplementary material, which is available to authorized users.

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Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG.


We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus.


The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett’s esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36–40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE.


A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.

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