A Diabetes Surgery Summit (DSS) Consensus Conference lançou, em dezembro de 2009, direcionamentos para o tratamento do diabetes tipo 2 através de cirurgias do aparelho digestivo.
Em resumo:
"In acceptable surgical candidates with a BMI of 35 kg/m2 or more whose disease is inadequately controlled by lifestyle and medical therapy, gastrointestinal surgery, such as RYGB, laparoscopic adjustable gastric banding, or biliopancreatic diversion, should be considered for the treatment of T2DM (level of evidence, A)."
"In suitable surgical candidates with mild to moderate obesity (BMI 30 - 35 kg/m2), a surgical approach may also be appropriate as a nonprimary option to treat inadequately controlled T2DM (level of evidence, B). RYGB may be an appropriate surgical option to treat diabetes in these patients (level of evidence, C)."
"In early clinical studies, novel gastrointestinal surgical techniques (eg, duodenal-jejunal bypass, ileal interposition, sleeve gastrectomy, and endoluminal sleeves) have shown promising results for the treatment of T2DM. At present, however, they should be used only in the context of institutional review board–approved and registered trials."
"Important research priorities include identifying new and more appropriate parameters for surgical indications, defining indications for surgery in less obese or overweight patients, and studying the mechanisms of action in gastrointestinal metabolic surgery."
Um ano antes (dezembro de 2008), o Conselho Federal de Medicina e a Sociedade Brasileira de Endocrinologia e Metabologia lançaram seu posicionamento. A recomendação é limitar a cirurgia para IMC > 35, usando as técnicas consagradas, até que surjam novas evidências para IMC menor que este. Novas técnicas deveriam se restringir a pesquisas acadêmicas.
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