For Medical Professionals

Overview

Are you a medical professional who knows a patient that would benefit from bariatric surgery? Refer them to us by calling 216.445.2224.

We have made available much of the medical literature that our doctors have published on bariatric surgery below:

STAMPEDE

Our most recent and widely celebrated STAMPEDE (Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently) study has been widely praised for it's investigation into the efficacy of surgical and medical intervention in diabetes treatment. Read more about it below or proceed with reading other resources published by our doctors.

The STAMPEDE Study

Cleveland Clinic physicians started a one-year clinical trial (with a four-year follow-up) to discover the effects on diabetic patients of advanced medical therapy versus medical therapy plus one of two types of bariatric surgery on glycemic control in obese patients with uncontrolled type 2 diabetes. 

On March 31, 2014, the three years study results were simultaneously presented at the American College of Cardiology's annual conference in Washington, D.C., and appeared in the New England Journal of Medicine. The study shows bariatric surgery is a highly effective and durable treatment for type 2 diabetes in obese patients, enabling nearly all surgical patients to be free of insulin and many to be free of all diabetic medications three years after surgery. The bariatric surgery patients experienced an improvement in quality of life and a reduction in the need for cardiovascular medications to control blood pressure and cholesterol compared to those receiving medical therapy.

This is the first randomized controlled clinical trial that compares surgery with intensive medical therapy head-to-head for this patient population.

The clinical trial involved 150 men and women with a clinical diagnosis of type 2 diabetes between the ages of 20 and 60 years old with a Body Mass Index (BMI) of 27-43.

This is one of the first times doctors have studied a weight loss surgery for diabetes in patients that aren’t severely obese. (Typically, bariatric surgery is performed on patients with a BMI over 35.)

The patients were randomized 1:1:1 and given one of the following treatments:

• 50 patients treated with Advanced Medical Therapy (AMT – diet, exercise, and medication therapy)
• 50 patients treated with Laparoscopic Sleeve Gastrectomy and AMT
• 50 patients treated with Roux-en-Y Gastric Bypass and AMT

STAMPEDE patients’ follow-up visits were scheduled for every three months for the first two years and every six months thereafter. All of the patients have completed at least one full year of post-treatment observation, and will continue to be observed for a total of 60 months.

Advisory Service

Cleveland Clinic’s Advisory Services is prepared to help you take your program to the next level. We offer a range of protocols, insights and assistance to increase the value of your bariatric surgery program.

• Learn more about our Bariatric Advisory Services

DrConnect at Cleveland Clinic

Provides referring physicians secure online access to real-time information about their patients' treatment progress while at Cleveland Clinic.

• Learn more

Cleveland Clinic Florida Bariatric & Metabolic Institute

Cleveland Clinic Florida's Bariatric & Metabolic Institute and Section of Minimally Invasive Surgery work with patients who are in need of weight loss through bariatric surgery.

In addition, Cleveland Clinic Florida’s multidisciplinary team approach provides convenient access to nearly 180 Cleveland Clinic physicians with expertise in 35 specialties, resulting in better patient care.

• Learn more about the program

Journal Articles

General Surgical and Laparoscopic Articles

Articles about general surgery news, laparoscopic gastric bypass surgery, surgical management of obesity, gastrointestinal surgery for severe obesity and more.

• Acute changes in renal function after laparoscopic gastric surgery for morbid obesity. Surgery for Obesity and Related Diseases. (2006).
• Bariatric Surgery a Review. General Surgery News. (April 2001).
• Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases. (2006).
• Laparoscopic gastric plication for treatment of severe obesity. Surgery for Obesity and Related Diseases. (2010).
• Laparoscopic Roux-En-Y Gastric Bypass in Morbidly Obese Adolescents. Journal of Pediatric Surgery. (2003).
• Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surgical Endoscopy and Other Intervention Techniques. (2006).
• Laproscopic Surgery for Morbid Obesity. Surgical Clinics of North America. (2001).
• Medical and surgical options in the treatment of severe obesity. The American Journal of Surgery. (2002).
• Open and Laparoscopic Surgical Modalities for the Management of Obesity. The Society for Surgery of the Alimentary Tract, Inc. (2003).
• Gastrointestinal Surgery for Severe Obesity. National Institutes of Health Consensus Development Conference Statement. (March 25-27, 1991).
• Perioperative management of the bariatric surgery patient: Focus on cardiac and anesthesia considerations. Cleveland Clinic Journal of Medicine. (2006).
• Risks and benefits of bariatric surgery: Current evidence. Cleveland Clinic Journal of Medicine. (2006).
• The Surgical management of obesity. Schwartz's Principles of Surgery. (2010).
• The impact of laparoscopic bariatric workshops on the practice patterns of surgeons. Surgical Endoscopy and Other Intervention Techniques. (2006).
• Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients. Surgery for Obesity and Related Diseases. (2010).
• Treatment of refractory gastroesophageal reflux disease with radiofrequency energy (Stretta) in patients after Roux-en-Y gastric bypass. Surgical Endoscopy and Other Intervention Techniques. (2006).

Effects of Bariatric Surgery on Co-Morbidities

Information on bariatric surgery and cirrhosis, early intervention of diabetes, the effect of laparoscopic gastric bypass surgery on type 2 diabetes and more.

• Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients. Cleveland Clinic Journal of Medicine. (2010).
• The Chronic Inflammatory Hypothesis for the Morbidity Associated with Morbid Obesity: Implications and Effects of Weight Loss. Obesity Surgery. (2004).
• Effect of Bariatric Surgery on Cardiovascular Risk Profile. The American Journal of Cardiology. (2011).
• Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus. Annals of Surgery. (2003).
• Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Annals of Surgery. (2003).
• Gerd and Obesity. Laparoscopic Bariatric Surgery. (2005).
• Surgery as an effective early intervention for diabetes. Diabetes care. (2005).
• Surgical Management of Gastroesophageal Reflux Disease in Obese Patients. Seminars in Laparoscopic Sugery. (2001).
• Surgically-Induced Weight Loss Significantly Improves Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome. Annals of Surgery. (2005).

Outcomes

Articles about the outcomes and approaches for laparoscopic weight loss surgery and laparoscopic gastric bypass surgery for severe and morbid obesity.

• Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Annals of Surgery. (2000).
• Surgical Approaches to the Treatment of Obesity: Bariatric Surgery. Endocrinology and Metabolism Clinics of North America. (2011).
• Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Diseases. (2009).

Equipment, Techniques and Training

Information on the operating room setup for laparoscopic gastric bypass and laparoscopic gastric banding; equipment, instrumentation, training, credentialing, and the learning curve for laparoscopic gastric bypass surgery, and current techniques.

• Elective Cholecystectomy During Laparoscopic Roux-En-Y Gastric Bypass: Is it Worth the Wait?. Obesity Surgery. (2002).
• Endoscopic balloon dialation of gastroenteric anastomotic stricture after laparoscopic gastric bypass. Endoscopy. (2003).
• Equipment and instrumentation for laparoscopic bariatic surgery. Update: Surgery for the Morbidly Obese Patient. (2002).
• Laparoscopic Gastric Bypass Surgery: Current Technique. Journal of Laparoendoscopic & Advanced Surgical Techniques. (2003).
• Operating room setup and patient positioning for laparoscopic gastric bypass and laparoscopic gastric banding. The Sages Manual: Perioperative Care in Minimally Invasive Surgery. (2006).
• The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surgical Endoscopy and Other Interventional Techniques. (2002).
• Training and credentialing for the performance of laparoscopic bariatric sugery. Laparoscopy and SLS Report. (2003).

Complications from Bariatric Surgery

Articles about gastric bypass leading to an increase in bone turnover and decrease in bone mass; prevention and management of complications of laparoscopic bariatric surgery and laparoscopic gastric bypass surgery.

• Laparoscopic Bariatric Sugery. Prevention and Management of Laparoendoscopic Surgical Complications. (2005).
• Gastric Bypass Surgery for Morbid Obesity Leads to an Increase in Bone Turnover and a Decrease in Bone Mass. The Journal of Clinical Endocrinology & Metabolism. (2004).
• Gastrointestinal Complications of Laparoscopic Roux-en-Y Gastric Bypass Surgery: Clinical and Imaging Findings. Radiology. (2002).
• Management of Complications After Laparoscopic Gastric Bypass. Annals of Surgery. (2000).

Fellowships

This program is a combined clinical and research fellowship, with heavy emphasis on the science and surgical management of morbid obesity. This program is designed to produce academic leaders in the fields of laparoscopic and bariatric surgery.The program is characterized by a high volume of laparoscopic bariatric cases, including gastric bypass, sleeve gastrectomy, and laparoscopic band placement. This is in addition to ample laparoscopic foregut, colon, abdominal wall, and solid organ cases. There is an active interest in the modern management of GERD, including novel diagnostic modalities and endoscopic and laparoscopic treatment of this disease. Graduating fellows have typically completed over 200 cases. Fellows also perform over 100 endoscopic cases including feeding access, anastomotic dilations and colonoscopy.

Research is an integral component of the program. Fellows are strongly encouraged to conduct clinical studies and present results at national meetings. Each clinical fellow is expected to submit at least one manuscript as first author for publication. Fellows in the 2-year track enjoy close collaboration with colleagues in the basic sciences and molecular biology departments. There is a well-equipped and staffed facility for animal experiments.

Teaching skills for bariatric surgeons can be refined through numerous academic workshops and courses that are sponsored by the department. Fellows participate in preparation and delivery of lectures, and in hands-on instruction of attendees. These meetings afford opportunities to cultivate long-term professional and collegial relationships with world experts in their respective fields.

This fellowship participates in the NRMP. Please apply through the fellowshipcouncil.org website for consideration. Deadlines and application information are included on the web site.