Spotlight on:
ASMBS Clinical Issues Committee

Published in July/August 2015 Issue             

A Q&A with Committee Chair Shanu Kothari, MD

The mission of the Clinical Issues Committee is to create evidence-based guidelines and position statements regarding clinical issues to enhance quality in bariatric surgery, patient care and to support ASMBS member practice. Connect checks in on the progress of the committee this year.

What are the objectives for the committee
this year?

The standing objectives of the committee are to identify existing and emerging gaps in guidelines/position statements, to increase understanding of clinical issues, and to establish and disseminate standards and protocols.

What activities are currently engaged in?

The Public Education Committee is responsible for educating the public about bariatric surgery, to improve the medical care and treatment of people with obesity and
related diseases.

Standardized Reporting Outcomes for Bariatric Surgery

This writing group, led by Stacy Brethauer, consists of Julie Kim, Naveen Ballem, Ann Rogers, Pavlos Papasavas, Maher El Chaar, Dan Eisenberg, Mark Kligman, and myself. Currently, there is too much heterogeneity in the literature with regards to reporting of outcomes. The goal of this statement was to develop standardized guidelines for outcome reporting in the bariatric literature. This includes agreed upon terms for remission of a variety of obesity related comorbidities including diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea to name a few. In addition, we have defined terms for follow up and agreed upon terms for weight loss. This will allow a more standardized approach to publications when comparing various surgical procedures and will allow our medical colleagues to understand the impact of metabolic surgery easier when compared to conventional therapy. The senior editors of SOARD (Dr.Harvey Sugerman) and Obesity Surgery (Scott Shikora) have both agreed to require submissions to their respective journals to abide by these guidelines.

Alcohol Use after Bariatric Surgery

This writing group led by Manish Parikh includes Naveen Ballem and Jason Johnson. They have created an important and timely position statement on the effect of alcohol after bariatric surgery, especially gastric bypass. It outlines the issue, the pharmacokinetics, and the role of screening in the patient population both pre and postoperatively.

Revision of the Prevention and Detection of Gastrointestinal Leak after Gastric Bypass including the Role of Imaging and Surgical Exploration-

This writing group was led by current CIC co-chair: Julie Kim and consists of Eric DeMaria, Dan Azagury, Guilherme Campos and Dan Eisenberg. One of the roles of the co-chair is to review the current statements to see if they are in need of an update or revision based on the current published literature. This statement was recently updated to include management of leaks after sleeve gastrectomy since the sleeve was not very popular at the time of the original publication.

ASGE/SAGES/ASMBS: Role of Endoscopy in the Bariatric Surgery Patient

This was a collaborative project between ASMBS, SAGES, and ASGE outlining the diagnostic and therapeutic role of endoscopy in currently performed bariatric procedures.

In addition to the above projects, under Dr. John Mortonís leadership, we have begun working relationships with ADA, AHA, AHKSS, and the lipid society that we hope to foster into collaborative statements in the near future.

Why these activities and how were they identified?

There are several avenues that ideas for guidelines and position statements can come from. Some come from the EC and some come from the members of the clinical issues committee themselves. In addition, each year, we do a call for statements from the members of the ASMBS. These are then vetted by the chair/co-chair of the CIC and ultimately approved by the EC for the CIC to begin creating approved statements.

What do you think the impact these activities will have on
clinical practice?

The goal of these statements is to provide guidance to members on a variety of clinical topics. They are based on best evidence, meant to reflect the societyís position on a variety of topics, and serve as a valuable resource for members and fellows in training.

What is the timing of publication and how will they be published?

Once the CIC completes a draft, it goes to legal and the EC for approval. This is followed by a three week time period that ASMBS members can comment on the draft. Once member comments are incorporated, the draft goes back to the EC for final approval prior to publication in SOARD and dissemination.

What has your experience been like as chair of this committee?

It has been a privilege to serve the society in this capacity. Succession planning in leadership is key and ASMBS does this quite well. I had the benefit of learning from Stacy Brethauer, immediate past Chair of the CIC. Julie Kim is the current co-chair and a tremendous resource. Teresa White from the ASMBS staff is a joy to work with. In addition, I have learned much from my professional colleagues as well as our integrated health partners. I am surrounded by talented committee members who care deeply about bariatric patients and developing best practice guidelines - they are the ones who deserve the credit.

How would you characterize the year for the committee?