Of patients recruited between September 1, 1987, and January 31, 2001, 260 of 2,037 control patients and 343 of 2,010 surgery patients had type-2 diabetes at baseline. Obesity Surg. Bazian, Ltd., eds. Aetna Provider Phone Number for below plans - 800-624-0756. 04-E028-2. The Task Group stated that registered dietitians are best qualified to provide nutritional care, including pre-operative assessment and post-operative education, counseling, and follow-up. The mean interval from SG to RYGB was 32.6 months (range of 8 to 113). Sugerman HJ, Londrey GL, Kellum JM, et al. Gastric restrictive surgery for clinically severe obesity in adults. Aetna Better Health of Kentucky (855) 300-5528. The greater omentum, which weighed 0.82 kg (95 % CI: 0.67 to 0.97), was removed from subjects who had omentectomy in both studies. 2021;31(2):570-579. There was moderate-quality evidence for improvement in most metabolic parameters in subjects assigned to IGB therapy as compared to conventional non-surgical therapy in RCTs: mean difference (MD) in fasting glucose change: -12.7 mg/dL (95 % confidence interval [CI]: -21.5 to -4); MD in triglycerides: -19 mg/dL (95 % CI: -42 to 3.5); MD in waist circumference: -4.1 cm (95 % CI: -6.9 to -1.4); MD in diastolic blood pressure: -2.9 mm Hg (95 % CI: -4.1 to -1.8). Guidance on the use of surgery to aid weight reduction for people with morbid obesity. Sharaiha et al (2015) stated that novel endoscopic techniques have been developed as effective treatments for obesity. Gonzalez R, Bowers S, Venkatesh K, et al. Once a tab is selected, type CTRL F on your keyboard, and type in the name . The highly sensitive diagnostic tests were upper GI series (91 %) and gastroscopy (96 %). These investigators evaluated the safety, technical feasibility, and clinical outcomes for ESG. Surg Obes Relat Dis.
EWL(%), EBMIL(%), TWL(%), anti-diabetic effect, complications, and revision rate were compared between the 2 groups. Lifestyle intervention comprised a 15-session diet and behavioral education program; 10 of the 11 subjects who underwent aspiration therapy and 4 of the 7 subjects who underwent lifestyle therapy completed the 1st year of the study. Amaral JF, Thompson WR, Caldwell MD, et al. It involves laparoscopic construction of a large and elongated gastric pouch and a loop gastric bypass with distal diversion (200 cm or up to 50 % of the small bowel) to reduce food absorption. Mean BMI at revision time was 36 ± 9 kg/m2, and 30.8 ± 5.2 kg/m2, 28 ± 4.9 kg/m2, and 28 ± 4.3 kg/m2 after 6, 12, and 24 months, respectively. Routine liver biopsies (68 consecutive patients) and selective liver biopsies (additional 86/174, 49 %) were obtained.
Overall, vitamin A, selenium, and iron deficiency were the most common nutritional deficiencies with the possibility of the protein malnutrition in up to 34 % of the patients when measured. This may be especially relevant when considering the extended length of time that it could take to reverse DKD. Pre-operative tests provided correct diagnosis in 63 % of barium contrast swallows, 50 % of upper GI endoscopies and 29 % computed tomographies. 18-month weight loss was 23 % EWL (8.8 % TWL) for vBloc and 10 % EWL (3.8 % TWL) for sham (p < 0.0001). Colquitt J, Picot J, Loveman E, Clegg AJ. Surgery for morbid obesity in adults. After 12 weeks, plasma PP responses were suppressed (20 +/- 7 versus 42 +/- 19 pg/ml). Mayo Clin Proc. Ikramuddin S, Korner J, Lee WJ, et al. Lancet. Baltimore, MD: CMS; February 21, 2006. Obes Surg. Morbidly obese subjects were enrolled in a single-arm, open-label, prospective trial and implanted with the DJBL. The USPSTF found adequate evidence that behavior-based weight loss interventions in adults with obesity can lead to clinically significant improvements in weight status and reduced incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels.
Change in disease status following bariatric surgery: Clinical evidence. Spaulding L et al. Complications following RYGB include: incisional hernia (13 %), anastomotic leak (8.7 %), respiratory failure (8.7 %), fistula (8.7 %), and perforation (4.35 %). Endoscopy. One conversion to open surgery was reported and 7.4 % required the placement of additional ports. Effect of the gastric balloon versus sham procedure on weight loss in obese subjects. Obes Surg. The authors concluded that aspiration therapy appeared to be a safe and effective long-term weight loss therapy for obesity. 1999;9(3):258-260. ), licensed by the state to practice dentistry, and practicing within the scope of that license. Job DescriptionWe are currently seeking a Behavioral Health Medical Director for Aetna Better Health of Kentucky, supporting Aetna Medicaid Region 3 (Florida, Kentucky and Louisiana) as well as behavioral health coverage for any of the Medicaid plans as needed. Jensen MD, Ryan DH, Apovian CM, et al. 2015;25(8):1534-1538. Double-blind, sham-controlled, crossover evaluation of 500-milliliter balloon. Ponce J, Woodman G, Swain J, et al; REDUCE Pivotal Trial Investigators. A problem with the traditional procedure is that the staples can break down, causing the stomach to regain its original shape – and patients to start gaining weight again.
Follow-up was available on 109 patients (61 %) at 5 years and on 87 patients (53 %) at 6 years; 6 patients did not have any follow-up. The authors stated that few clinical studies about the safety and efficacy of AspireAssist have been carried out and published. Rutledge R. Similarity of Magenstrasse-and-Mill and Mini-Gastric bypass [letter]. National Institutes of Health (NIH), National Heart, Lung and Blood Institute (NHLBI). Improvement in cardiovascular risk scores, HbA1c, and BMI were greater after surgery. Am J Gastroenterol. Weight loss and diabetes remission were greatest in patients undergoing bilio-pancreatic diversion/duodenal switch, followed by gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Mean excess weight loss was 46.6 % (range of 35.2 to 58.9). If you did not intend to leave our site, click or tap the "x" in the upper right-hand corner. Surg Obes Relat Dis. The Task Group recommended that all weight loss surgery patients be encouraged to lose weight before surgery, and to promote 5 to 10 % pre-operative weight loss in patients with a BMI greater than 50 kg/m2 or obesity-related comorbidities (Saltzman et al, 2005). Furthermore, there were reductions in hyperlipidemia, sleep apnea, and hypertension at 12 months. 1989;261(10):1491-1494. Overcash (2008) reported 2 cases of the safe and successful use of the StomaphyX device to alter the flow of gastric contents and repair gastric leaks resulting from bariatric revision surgery.
1998;5(26):95-97. A total of 1,759 LSG was performed as primary bariatric procedure from 2005 to 2017 with mean age of 35.2 ± 10.3 years (14 to 71), female 69.7 %, mean BMI 37.9 ± 7.7 kg/m2, and mean waist width 113.7 ± 17.9 cm. The authors concluded that the findings of this study established that AT is a safe, effective, and durable weight loss therapy in people with classes II and III obesity in a clinical setting.
Bibiliography update: Surgical treatment of morbid obesity.
Bariatric/metabolic surgery to treat type 2 diabetes in patients with a BMI <35 kg/m2. Brooks M. Five deaths tied to intragastric balloons, FDA says. 2018;118:e59-e71. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the US Preventive Services Task Force: Evidence Synthesis No. In a retrospective study, a total of 47 cases of CCS that underwent Candy cane (CC) resection were analyzed for pain remission to examine if intussusception is a possible underlying mechanism. When comparing patients in the 75th with those in the 25th percentile of pre-operative weight loss, the risk of complications was reduced by 13 %. The U.S. Preventive Services Task Force (USPSTF, 2019) recommends that clinicians offer or refer obese adults to intensive, multicomponent behavioral interventions (ie, behavior-based weight loss and weight loss maintenance interventions). 1984;50(9):496-501. Eisenberg D, Azagury DE, Ghiassi S, et al. Sullivan S, Stein R, Jonnalagadda S, et al. Rigaud D, Trostler N, Rozen R, et al. 1999;75(879):7-12. The CTAF assessment found few comparative studies of sleeve gastrectomy. Lindor KD, Hughes RW Jr, Ilstrup DM, Jensen MD.
The TORe group had reduced systolic and diastolic blood pressure (p < 0.001) and a trend toward improved metabolic indices. It extends from the duodenum to the proximal jejunum. Rubin M, Yehoshua RT, Stein M, et al. For diabetes assessment, the median follow-up time was 10 years (interquartile range [IQR], 2 to 15) and 10 years (IQR, 10 to 15) in the control and surgery groups, respectively. Obes Surg. Advances in the surgical treatment of obesity. Surgery for morbid obesity. of 31.5 ± 26.7 % of their excess body weight (12.1 ± 9.6 % total body weight), whereas those in the Lifestyle Counseling group had lost a mean of 9.8 ± 15.5 % of their excess body weight (3.5 ± 6.0 % total body weight) (p < 0.001).
Conversion from gastric bypass to sleeve gastrectomy for complications of gastric bypass. Our dedicated customer support team is available to answer any questions you may have and guide you through your shopping experience: Email: support@healthsqyre.com Live Chat: Every day, 8am – 5pm (MT), Find answers to frequently asked questions and access support resources at our Help Center, Email us anytime at support@healthsqyre.com, Typically, filter replacements are every 30 days, Typically, tubing replacements are every 3 months, Typically, mask replacements are every 3 months, BiPAP Machine (without backup rate feature), https://www.healthsqyre.com/education/wp-content/uploads/2021/01/hs-header-logo-new.png, https://www.healthsqyre.com/education/wp-content/uploads/2020/09/aetna-cpap-coverage.png, Wellmark Blue Cross Blue Shield of South Dakota – CPAP Coverage. Camilleri M, Toouli J, Herrera MF, et al. A total of 503 subjects were enrolled at 15 centers. The authors concluded that in this very long-term follow-up observational study of obese patients with type 2 diabetes, bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care. The first 2 GERD patients had incomplete procedures due to instrument malfunction. Issue 79. The 30-day post-operative major complication occurred in 25 (1.4 %) patients. This means that if you’re close to meeting your deductible, you may be eligible to buy your supplies with us at almost zero-cost!
The authors concluded that the findings of this study showed that some patients may present following LSG with refractory GERD or inadequate weight loss, but that conversion to RYGBP or BPD/DS may be done safely and effectively. Bona and associates (2019) noted that post-operative leak and IAI are common following bariatric surgery with a significant impact on peri-operative outcomes, hospital LOS, and re-admission rates. Patients with severe obesity (BMI greater than or equal to 35) aged 19 to 79 years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4 integrated health systems in the United States (n = 5,301) were matched to 14,934 control patients on site, age, sex, BMI, hemoglobin A1c, insulin use, observed diabetes duration, and prior health care utilization, with follow-up through September 2015. Policy. KY HEALTH Provider Education Webinars Reminder . Accessed: August 18, 2003. Job Description We are currently seeking a Behavioral Health Medical Director for Aetna Better Health of Kentucky, supporting Aetna Medicaid Region 3 (Florida, Kentucky and Louisiana) as well as behavioral health coverage for any of the Medicaid plans as needed. The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance (HOMA-IR) and diabetes remission. These researchers evaluated the impact of omentectomy added to bariatric surgery on metabolic outcomes. A total of 242 patients underwent open and laparoscopic RYGBP from 1998 to 2001. The authors concluded that as previously reported by studies in which post-surgical biopsies were performed, RYGB leads to a great resolution rate of liver fibrosis. Although the long-term effectiveness of weight reduction programs has been questioned, the Institute of Medicine (1995) has reported the substantial short-term effectiveness of certain organized physician-supervised weight reduction programs. In cases of DM2, SADI-S was preferable over a sleeve gastrectomy alone.
However, long-term follow-up is still needed.
Anthone GJ, Lord RV, DeMeester TR, Crookes PF.
Both patients were at a high risk and could not undergo another open or laparoscopic surgery to correct the leaks that were not healing.
2014;10(6):1135-1139. Yes, Aetna requires documentation to cover CPAP therapy supplies. The assessment noted that, due to limited evidence and poor quality of the trials comparing each pair of procedures, these conclusions should be viewed with caution. A CRP of greater than or equal to 5 mg/dL had a sensitivity for a complication of 27 % and a specificity of 88 %. The mean age of the trial populations was 42.3 years and mean pre-operative BMI was 48.8 kg/m². 1993;1:295-298. A meta-analysis of the 11 published randomized clinical trials (RCTs) directly comparing bariatric/metabolic surgery versus a variety of medical/lifestyle interventions for T2DM provided level 1A evidence that surgery is superior for T2DM remission, glycemic control, and HbA1c lowering. Gastric restriction can be restored by surgical placement of a silastic ring or an adjustable gastric band around the pouch. The last 75-100 cm then becomes the "common channel", measuring about 10 % of the total small bowel length and is the only portion that can absorb fat. Fisher BL, Buchwald H, Clark W, et al. Effectiveness of weight management programs in children and adolescents. The mean operative time was 87.3 mins without any intra-operative complications. Zechmeister-Koss I, Huić M, Fischer S; European Network for Health Technology Assessment (EUnetHTA). Miller K, Hell E. Laparoscopic adjustable gastric banding: A prospective 4-year follow-up study.
Main outcome measures were diabetes remission, relapse, and diabetes complications. Devices in both groups performed regular, low-energy safety checks. Two patients required further surgery due intractable vomiting and total dysphagia; in 1 the plication unfolded, and in the 2nd it was converted into vertical gastrectomy. These investigators reported their experience with use of short-limb RNY reconstruction for failed anti-reflux procedures. Aetna Better Health of Kentucky is not responsible or liable for content, accuracy or privacy practices of linked sites or for products or services described on these sites. ", More recently, evidence-based guidelines from the Scottish Intercollegiate Guidelines Network (2010) have stated that bariatric surgery should be considered on an individual case basis following assessment of risk/benefit in obese patients with "evidence of completion of a structured weight management programme involving diet, physical activity, psychological and drug interventions, not resulting in significant and sustained improvement in the comorbidities.". The following recommendations are currently endorsed by the ASMBS regarding SADI-S for the primary treatment of obesity or metabolic disease: While the updated ASMBS statement (Kallies and Rogers, 2020) endorses SADI-S as an appropriate metabolic bariatric surgical procedure, it also points out that studies of long-term safety and efficacy are still needed – a view that is supported by the studies described above. JAMA. 6 Aetna self-insured plan sponsors offered this waiver at . Given its role in metabolic regulation, the gastro-intestinal tract constitutes a meaningful target to manage T2DM. 2012;379(9833):2300-2311. Baltasar A, Bou R, Bengochea M, et al. Surve A, Cottam D, Medlin W, et al. 2003;26(2):101-104. 2013;20(6):594-599. However, there is insufficient evidence to recommend it as the new gold standard for sleeve gastrectomy in the place of conventional laparoscopic sleeve gastrectomy. Himpens J, Dapri G, CadiGB. Third, the number of available labs was insufficient to make any definite conclusion on the nutritional outcomes. Moreover, they stated that these findings require confirmation in randomized trials. A fatty liver is heavy, brittle, and more likely to suffer injury during surgery. Diabetes was improved or in remission in 89.2 % of patients, and 64.7 % of patients was in remission. Obesity Surgery. Available at: http://www.asbs.org/Newsite07/resources/sleeve_statement.pdf. Gastric bypass surgery has been used to treat morbid obesity and its co-morbidities, and IIH has recently been considered among these indications. The effectiveness of single-anastomosis duodenoileal bypass with sleeve gastrectomy/one anastomosis duodenal switch (SADI-S/OADS): An updated systematic review. vBloc patients largely maintained 12-month weight loss of 26 % EWL (9.7 % TWL). If this goal is achieved, further weight loss can be attempted, if indicated through further evaluation. A total of 6 RCTs concerning 410 total obese T2DM patients were included. Bariatric procedures (76 % RYGB, 17 % sleeve gastrectomy, and 7 % adjustable gastric banding) were compared with usual care for diabetes. Electrodes were implanted laparoscopically on both vagi near the esophago-gastric junction to provide electrical block. 1999;11(2):93-97. Vitamin D (calciferol) refers to a group of lipid-soluble prohormones; the 2 major forms of which are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Guidelines of the American Association of Clinical Endocrinologists and the American College of Endocrinology (1998) and guidelines on obesity surgery from the Massachusetts Department of Health and Human Services (2006) state that surgery candidates should be severely obese for a period of time. Schouten R, Rijs CS, Bouvy ND, et al. 2017;10:311-316. At 10 years, the overall revision rate was 21.5 % (14/65) and 11 (16.9 %) of 65 patients were converted to RYGB. Aetna CareUnify is a Population Health Management system for healthcare providers and health plan resources to connect and manage patients' continuity of care through multiple care settings. After 4 weeks taking a very-low-calorie diet, 25 obese men and women (BMI 39.8 ± 0.9 kg/m(2)) had the AspireAssist gastrostomy tube placed during a gastroscopy. An assessment of laparoscopic RYGB by the BlueCross BlueShield Association Technology Evaluation Center (BCBSA, 2005) stated that among available bariatric surgical procedures, RYGB appears to have the most favorable risk-to-benefit ratio, and that the overall risk-to-benefit ratio of laparoscopic RGBY is similar to that of open RGBY. Orbera Intragastric Balloon System - P140008. Enochs et al (2020) noted that the sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and SADI-S are recognized bariatric procedures. The total weight loss from surgery can be enhanced if it is combined with a low-calorie diet. Follow-up was incomplete (82 % at 5 years), creating an opportunity for bias.
A total of 28 CC revision cases were identified (mean age of 45 ± 9 years, women/men – 9:1). Obes Surg. It can occur as an early and late complication. Medically Frail Attestation Forms . Single anastomosis duodeno-ileal switch (SADIS): A systematic review of efficacy and safety. 2009;9(22):1-23. Position of the American Dietetic Association: Weight management. The authors concluded that short-limb RNY reconstruction was an effective remedial procedure for a subset of patients with failed anti-reflux surgery, but morbidity was significant.
Report IRR No.
Sjostrom et al (2014) noted that short-term studies showed that bariatric surgery causes remission of diabetes. The EndoBarrier, an endoscopically delivered duodeno-jejunal bypass liner (DJBL), is a plastic flexible tube that is placed in the duodenal bulb, directly behind the pylorus. Through-the-scope balloons were used in 16 studies (69.5 %) and Savary-Gilliard bougies in 4 studies. Surg Endosc. *As hours of operation may change, please call the provider to verify the office hours. Moreover, they stated that the main drawback of this study was retrospective studies performed on prospective databases. The other 54 patients remained at LSG anatomy, but 45 % of them required PPI for reflux symptoms. Ann Intern Med.
2018;28(10):2991-2997.
Body mass index (BMI) (see appendix) exceeding 40 measured prior to preoperative preparatory program; BMI greater than 35 measured prior to preoperative preparatory program in conjunction with, Clinically significant obstructive sleep apnea (i.e., person meets the criteria for treatment of obstructive sleep apnea set forth in. By inducing regression or remission of T2DM, bariatric surgery may also have the capability to effectively treat DKD. The most common complications were anastomotic strictures, bowel obstructions, respiratory complications, and dumping. Escalona A, Pimentel F, Sharp A, et al. Humana Healthy Horizons in Kentucky.
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