October 2019 Edition
1. Letter From the President
Welcome to October and to my final Top 5 on the 5th President’s message as next month I hope we will all meet together in person at the ASMBS Annual Meeting being held at ObesityWeek 2019 in Las Vegas!
I have an exciting announcement to make today in order to keep our members up to date, looking forward, and thinking about the future of our practices and our specialty.
Over recent months, ASMBS has been updating our review of the loop single anastomosis duodenal switch-sleeve (SADI-S) in order to determine an update of our position on this procedure. As you may recall, in 2016 ASMBS published a position statement on SADI-S (referred to by several other names including SIPS) in which the procedure was called “investigational” and a call was made for more clinical studies to be completed in order to determine the potential for this new procedure.
As a reminder, the ASMBS has a robust process for evaluation of new procedures involving multiple steps at which we seek outcomes data, but also input from both society leadership as well as from the society’s membership. The SADI-S procedure was evaluated over a number of months. To highlight some of the process, and for the sake of transparency, the Clinical Issues Committee (CIC) under Ann Rogers’ leadership was tasked with updating the review of the peer-reviewed literature. The ASMBS Committee Chairs of CIC, Emerging Procedures and Technology (Dean Mikami), Insurance (Ash Kaul) and Quality/Patient Safety (Jon Gould) were convened to determine if the procedure should move forward, which led to holding a session of the Executive Council (EC) at our June meeting in Chicago in which we reviewed the data and also the testimony of 2 expert members of our society charged with representing the procedure favorably (Dan Cottam) and in opposition (Dan Leslie). After the presentations of evidence, the EC deliberated and then, as required by the rules of the process, more than 75% of the elected EC Board voted by secret ballot to send the question of endorsement for the procedure forward for member comment. Member comments received included more than 200 favorable supportive comments as compared to just 4 negative comments arguing against endorsement of the procedure. With the input of our membership in hand, the EC voted unanimously to recommend ASMBS endorsement of the SADI-S procedure.
The literature review of SADI-S provided the strongest foundation for endorsement, including a systematic review of the literature on SADI-S published in 2018 involving 12 eligible studies comprising a total of 581 patients (1). The full position statement of our society, with its detailed literature review, will be published in SOARD in the coming months.
I hope you agree that our new procedure evaluation process is robust and thorough. I personally believe that support was strong for the loop SADI-S in part because we recognize that SADI-S is a modification of a procedure which ASMBS already endorses, i.e. the classic Roux-en- y Duodenal Switch. One can logically argue that the modifications which comprise SADI-S reduce risks of the DS procedure including eliminating the technical challenges of the very distal entero-enterostomy anastomosis and lengthening the common channel in order to reduce malabsorption and malnutrition risks. Review of the available literature by leadership and others supports that this has been accomplished. Finally, when analyzing new procedures, in general we should consider safety of prime importance. In contrast to the evaluation of an entirely novel procedure, a procedure modification that purports to be safer than the original procedure should reasonably be considered early on, once the data supports improved safety.
So with this month’s message, I am announcing ASMBS’ endorsement of the loop single anastomosis duodenal switch-sleeve procedure. The EC and others have provided insight and advice about the implications of this endorsement. At present, the classic DS procedure comprises only one percent or less of all bariatric procedures done each year in the United States. So, in essence, many of us are unfamiliar with the procedure, and our united goal going forward should be the safe adoption of SADI-S for those members who wish to add this procedure to their practice. As a first step, the ASMBS Program Committee has added a full-day extensive post-graduate course on loop SADI-S to our meeting program on Sunday November 3rd, in Las Vegas to be directed by experienced SADI surgeons Drs. Dan Cottam and Bo Neichoy:
We hope everyone with interest in learning more about this procedure will consider attending this course. In addition, there are industry-sponsored courses occurring on a regular basis around the country that surgeons can attend to learn more from experienced colleagues. Finally, as with any new procedure, and often required by hospitals, surgeons should strongly consider requesting an experienced SADI-S surgeon to serve as a preceptor to facilitate safe performance of the operation.
It is probably worth a word of caution in closing. The laparoscopic SADI-S procedure involves a surgical anastomosis to the duodenum and this technically challenging anastomosis should be undertaken with caution by surgeons who already have a great deal of experience in performing successful GI anastomoses. Surgeons without this type of experience will experience a significantly longer and steeper learning curve that must be climbed safely. In addition, the DS procedure presents the potential for malabsorption of certain vitamins and other nutrients, including the possibility of protein calorie malnutrition, diarrhea and steatorrhea. Therefore, nutritional management of these patients will require close follow-up in the longterm as well as the input of our nutrition colleagues in order to provide for the longterm safety of patients. Surgeons interested in adding this procedure to their practices should carefully analyze their own capabilities as well as the capabilities of their multidisciplinary program in order to determine if they can introduce this procedure safely. A flood of new procedures resulting in complications occurring across the United States would clearly not be in the best interests of our specialty or our patients.
I am looking forward to seeing everyone in Las Vegas next month. As an organization, we have a lot of advances to celebrate this year, and I am proud to be able to provide our membership with a full report of what is happening in our specialty as part of my Presidential Address on November 6th. I hope to see you there!
With warm regards,
Eric J. DeMaria, MD, FASMBS
- Shoar S, Poliakin L, Rubenstein R, et al. Single anastomosis duodeno-ileal switch (SADIS): a systematic review of efficacy and safety. Obes Surg. 2018;28:104-13.
2. Your Vote Counts!
An outstanding group of surgeons and integrated health professionals has been nominated by the membership, and it is now time to select the new Society leadership. You will have the opportunity to review each candidate’s CV and statement before your place your vote. NOTE: You will only be able to access the ballot one time and need to complete all your votes during that session.
Click here to cast your vote for the Executive Council Elections
Only active regular members are eligible to vote on the executive council ballot.
Click here to cast your vote for the IH Executive Council Elections
Only active associate members are eligible to vote on the executive council ballot.
3. The ASMBS Annual Meeting at ObesityWeek News
Sell Your Publication at the ObesityWeek Bookstore
Submit your book, tape, CD, DVD, or other publication to be sold at the ASMBS Annual Meeting at ObesityWeek 2019! This offer is available to active ASMBS members, 2019 ASMBS Corporate Council members, and speakers or authors of papers being presented at our 36th Annual Meeting. Deadline approaching – complete the Bookstore Agreement Form by Friday, October 11th!
Attend the ASMBS Mason Lecture at ObesityWeek
Please join us on Wednesday, November 6th for a special session featuring this year’s Keynote Mason Lecturer, Dr. Philip R. Schauer. Dr. Schauer is a Professor of Surgery at the Cleveland Clinic Lerner Medical College and ASMBS Past President. View the session page for more information and watch the preview video on YouTube.
4. IH Presidential Message
Elections have begun for the Integrated Health (IH) Executive Council positions – 2 IH Member-at-Large positions and the IH Secretary position. There are several very qualified, dedicated and enthusiastic candidates for each position. Be sure learn about the candidates, and if you have not voted, please be sure to vote with this link: https://asmbs.org/election/ihec-candidates
A survey was sent out to the membership a couple of weeks ago looking for your feedback. The survey is approximately 8 questions long and is designed to help with the revision of the strategic plan for IH. As an incentive, ASMBS will provide free membership for 1 year to 1 lucky member – be sure to include your contact information to be eligible. Thank you to all that have responded. If you have not responded, please be sure to complete the survey: https://www.surveymonkey.com/r/2DXLW6R
The ASMBS Annual Meeting at ObesityWeek is rapidly approaching. The IH Program and Professional Education Committee has developed an agenda with topics that will appeal to many – CBN Review Course, Masters in Behavioral Health, Nutrition, IH Practice Management, Pharmacology and Developing 20/20 Vision for Running Bariatric Support Groups. Also, IH will feature symposiums for Advanced Practice Providers, Managing Diabetes Pre- and Post-op, Updates with the 2019 AACE/TOS/ASMBS Guidelines, IH Diversity and Inclusion, Tele-Health: The Good and the Bad, Medicinal Marijuana, IH Abstracts and of course professional networking groups. The Integrated Health section is very excited to share that the IH Keynote Speaker this year is Dr. Walter Pories. Please be sure to come and hear him speak. If you have not registered yet, please be sure to register with this link: ObesityWeek.com/Registration.
I look forward to seeing you in Vegas!! Safe travels.
Karen Flanders, MSN, ARNP, CBN
ASMBS IH President