Presentation on theme: "Endoluminal Duodenal-Jejunal Sleeve, Fat Reduction... And the Future"— Presentation transcript:
1Endoluminal Duodenal-Jejunal Sleeve, Fat Reduction... And the Future Francesco Rubino, MDChief, Section of Gastrointestinal Metabolic SurgeryDirector; Diabetes Surgery CenterWeill Cornell Medical College- New York Presbyterian HospitalNew York, NY USAFirst Canadian Summit on Metabolic Surgery for T2DMMontreal, May 6-7, 2010
26The Obesity Society (TOS) Int. Ass Study of Obesity (IASO) Diabetes UK DSS Reccommendations areEndorsed by:ASMBSIFSOThe Obesity Society (TOS)Int. Ass Study of Obesity (IASO)Diabetes UK26
27Surgery should be considered in pts with BMI > 35 and inadequately controlled diabetes. Bariatric surgery should be considered for adults with BMI > 35 kg/m2 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy. (B)
28Surgery may be considered as a non-primary alternative in pts with uncontrolled diabetes and BMIin patients with type 2 diabetes and BMI of 30–35kg/m2, there is currently insufficient evidence to generally recommend surgery in patients with BMI35 kg/m2 outside of a research protocol.
29Metabolic Surgery… the future Solving the BMI issue…
30DSS- BMIControlled clinical trials in these patients should be performed to determine the safety and efficacy of GI metabolic surgery (A) as well as to identify parameters other than BMI as criteria for appropriate patient selection (A).SAME LANGUAGE IN ADA’ STANDARDS OF CARE DOCUMENT
32Metabolic Surgery… the future Solving the BMI issue…Diabetes-specific criteria for surgical indicationRisk-Stratification in diabetesImprove Standards of Clinical Research
33Patient Factors and Outcomes Associated with T2DM Resolution (N=191) Schauer et al. Annals of Surgery Oct 2003
34The “Bad Reputation” of Bariatric Surgery * Any Textbook
35DSS- ResearchRandomized controlled trials are strongly encouraged to assess the utility of GI surgery to treat T2DM (A). In patients with BMI <35 kg/m2, determining the appropriate use of GI surgery for the treatment of T2DM is an important research priority (A).
36Diabetes Surgery Center Worldwide Consortium for Randomized Clinical Trials in Diabetes Surgery(WORLDCords)Diabetes Surgery CenterWeill Cornell Medical College-New York Presbyterian Hospital
37Medical Therapy and Lifestyle Modification Cornell’s StudyRYGB (Lap)vsMedical Therapy and Lifestyle ModificationPI: Francesco RubinoSteering Committee: H. Lebovitz, J. Buse, A. Goldfine, J. Roth B. Zinman, B. Wolfe, JP Despres, S. Belle
38Participating Countries REGIONAL Chapters:Europe (centers already available in Italy, Netherlands, Belgium, Spain, England,)South-Central America (Mexico?, Brasil, Argentina, Chile, Venezuela,)North America (Cornell, Tuffs, Univ. of Maryland, Mount Sinai?)Asia (Philippines, India, Taiwan, Japan)Middle East (Quatar, UAE, SA)
39International Consortium for Diabetes Surgery Weill Cornell –NYPStudy (50 pts)US Multicenter Study200 patientsWorldwide Consortium for RCTpts
40Metabolic Surgery… the future Solving the BMI issue…Diabetes-specific criteria for surgical indicationRisk-Stratification in diabetesImprove Standards of Clinical ResearchElucidation of Mechanisms of ActionNovel Surgical ProceduresEndoluminal ApproachesNovel Targets for DrugsRe-thinking of Diabetes and Obesity