Transcript Bariatric Surgery - — Diabetes in Berkshire West

Berkshire Weight Loss Surgery
Royal Berkshire Hospital, Reading
James Ramus, Consultant UGI & Bariatric Suregon
Background
• Obesity epidemic – 25% UK (no.5)
• Predicted 50% by 2050
• ‘metabolic syndrome’ – (x20 risk of DM if
BMI>35)
• NBSR 2010 – 27.5% DM
Treatment of obesity
• Diet/exercise
• Drugs
• Surgery – sustained weight loss
85.5% ‘resolution’ of DM (2 years)
0.1% overall mortality
average 57.8% EWL
Surgery for obesity
• Laparoscopic gastric (‘roux en Y’)
bypass
• Laparoscopic gastric band
• (Laparoscopic sleeve gastrectomy)
• Endoscopic gastric balloon
Normal Stomach
Gastric band
Gastric band
Gastric band
• 50-60% EWL within 2 years NBSR
• Day case – 1 night stay
• 50-75% ‘resolution’ of type 2 DM NBSR
Gastric bypass
Gastric bypass steps
Gastric bypass
• 60-85% EWL 2 years NBSR
• 2-4 night stay
• 60-90% ‘resolution’ of DM at 2 years NBSR
Sleeve gastrectomy
Sleeve gastrectomy
• 50-70% EWL
• 1-3 night stay
• DM resolution good but ?not quite as good
as post bypass
Gastric balloon
Gastric balloon
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?primary weight loss procedure
Sedation/ ‘light GA’ - Day case
Need to remove/replace after 6 months
20-30% EWL 6 months
Berkshire weight loss service
• Referral to consultant endocrinologist
• Assessment by full weight loss team
• Commencement of non surgical ‘tier 3’
management as necessary
• Referral to bariatric MDT clinic
• Surgery
• Lifelong follow-up by MDT
Criteria for surgery
• NICE
BMI >35 & comorbidity
BMI >40
• Clinical Commissioning Policy: Complex
and Specialised Obesity Surgery; April
2013 – advises commissioning based on
NICE guidelines
SIGN 2013
• ‘Obese adults with T2DM should be
offered individualised interventions to
encourage weight loss (including lifestyle,
pharmacological or surgical interventions)
…..’
ADA 2013
• ‘Bariatric surgery may be considered for
adults with T2DM with BMI >35
……in particular if diabetes or associated
comorbidities are difficult to control with
lifestyle and pharmacological therapy..’
NICE 2012
• prevention of DM July 2012 –
‘…if the above weight management
interventions have been unsuccessful, refer
people to a specialist obesity management
service (see NICE guidance on obesity)…’
Economic impact
• Obesity has been estimated to cost the
NHS £4.3 billion a year. Figures published
by the office of health economics in 2010
calculated that by operating on just 5% of
the eligible bariatric population, the
economic impact on the UK would be a
saving of approximately £191 million a
year.
Berkshire Weight Loss Surgery
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James Ramus
Marianne Sampson
Usha Ayyagari
Kathy Krzeminska
Kath Hallworth-Cook
Lisa Lovell
Rachael Brastock
Consultant Surgeon
Consultant Surgeon
Consultant Endocrinologist
Consultant Anaesthetist
Specialist Bariatric Nurse
Specialist Bariatric Dietitian
Consultant Clinical Pyschologist
• Please refer to Dr Usha Ayyagari, Berkshire Weight Loss Surgery,
Department of Endocrinology, Royal Berkshire Hospital, Reading
References
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The National Bariatric Surgery Registry. March 2010. Dendrite Clinical
Systems Ltd. Oxon
Shedding the pounds. Obesity management, NICE guidelines and Bariatric
Surgery in England. Nov 2010. Office of Health Economics. London
Scottish Intercollegiate Guidelines Network, Healthcare improvement
Scotland. SIGN March 2010
• American Diabetes Association. ADA. Standard of medical care in
diabetes – 2013. Diabetes Care. 2013;36 (suppl 1): S11-S66