Re: Aetna Policy Bulliten 157: Hepatic Liver Failure from BPD/DS?

[Guest guest]

OK,

I just had to do research on the liver problems:

The first study I found 3 patients out of 1250 that devloped hepatic

liver failure from BPD (no DS). That is 0.25% rate - very low it

seems to me.

Link:

http://clos.net/compare-mgb/biliopancreatic_diversion1.htm

I think Aetna is confusing the BPD with the even older JIB procedure.

Dr Rabkin's sight states:

" The first widely employed bariatric procedure, which induced weight

loss solely by causing malabsorption, was Jejunoileal Bypass (JIB).

Over time, JIB was found to carry unacceptable hepatic and renal

morbidity and mortality. "

In Hess's 1998 paper 1/440 patients died of liver and renal failure:

" Liver failure, renal failure, severe electrolyte imbalances etc. do

not seem to be a problem with this operation (BPD/DS), if the

patients have adequate follow-up and proper supplementation. "

And from:

Current Status of Medical and Surgical Therapy for Obesity

EDWARD C. MUN, GEORGE L. BLACKBURN, and JEFFREY B. MATTHEWS

" ..and the poor experience with jejunoileal

bypass caused a stigma to be associated with bariatric

surgery and probably hindered more widespread

application of improved operations for obesity. Survivors

of this procedure should be evaluated for liver and renal

dysfunction and for conversion to a more acceptable

anatomic construction whenever possible. "

I was NOT able to find the papers referenced by Aetna about liver

failure, and I would really like to get them (reference 2&3 from " The

List " ).

The other papers on the list may or may not have anything to say

about hepatic liver failure or any other problems with BPD/DS.

However, I suspect that many of them have statements similar to the

following from the above mentioned paper by Mun:

" Most bariatric surgeons are reluctant to

perform biliopancreatic diversion as a first-line antiobesity

procedure. "

Any help finding the references from the list is much appreciated.

Thanks,

Hull

> OK,

>

> I have sorted through the Aetna policy bulliten. The following is a

> subset of the papers sited as basis for their policy. We need to

> find these papers and debunk (or confirm) Aetna's evaluation. Most

> of the papers sited regard the adjustable gastric band, and I have

> ommitted those. In addition, several papers deal with BPD without

> the DS. Does the BPD/DS fix these problems?

>

> Please help in FINDING copies of these papers. This is the starting

> point we need to debunk Aetna and other insurance companies like

> BC/BS.

>

> If by chance we discover that there are real problems, than it will

> help the pre-ops in decision making as well as the post ops.

>

> Thanks,

>

> Hull

>

>

> The List:

>

> 1. Scopinaro N, Gianetta E, Friedman D et al. Biliopancreatic

> diversion for obesity. Problems Gen Surg 1992;9:362 - 79.

> 2. Grimm IS, Schindler W, Haluszka O. Steatohepatitis and fatal

> hepatic failure after biliopancreatic diversion. Am J Gastroenterol

> 1992;87:775 - 79.

> 3. Langdon DE, Leffigwell T, Rank D. Hepatic failure after

> biliopancreatic diversion. Am J Gastroenterol 1993;88:321.

> 4. Wylezol M, Pardela M. Contemporary methods of treatment of

> morbid obesity. Pol Merkuriusz Lek 1998 Aug;5(26):95 - 7.

> 5. Forestieri P, De Luca M, Formato A, Loffredo A, et al.

> Restrictive versus malabsorptive procedures: criteria for patient

> selection. Obes Surg 1999 Feb;9(1):48 - 50.

> 6. 16th Annual Meeting of the American Society for Bariatric

> Surgery. San Diego, California, USA. June 9 - 12, 1999. Abstracts.

> Obes Surg 1999 Apr;9(2):123 - 44.

[Guest guest]

>

> I was NOT able to find the papers referenced by Aetna about liver

> failure, and I would really like to get them (reference 2&3

from " The

> List " ).

you need to go to your local university medical library and

they will help you get them. You are in San Diego, aren't you? Go to

UCSD and their medical library.

B.

July 6th with Dr. Anthone.