Posted on July 6, 2010 in Latest News, Sleeves
For all you guys wondering what is going on with the Sleeve Gastrectomy in terms of insurance coverage and new research, here’s the scoop:
Insurance coverage: United Healthcare and Aetna (large mainland insurance companies) now cover the Sleeve Gastrectomy under standard NIH criteria. Medicare and local insurances still are reluctant to follow suit, but my guess is that they will do the same in the next year or two.
Basic Science: We have always thought of the Sleeve Gastrectomy as a restrictive procedure, where weight loss is acheived through limiting the amount of food intake. But this category is probably too simplistic. Ghrelin, a hormone produced in the stomach that signals hunger and fullness, is significantly reduced after this procedure. Also, people with diabetes see immediate improvement after this surgery which is most likely due to rapid transit of food to the ileum, initiating hormones that alter glucose metabolism.
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I have had plenty of Band patients express concern for a Band Erosion after they searched the Internet for answers to some of the quirky sensations they may be having. I want to clarify what a Band Erosion is. Basically, for some reason or variety of reasons, the silicone band around the top part of your stomach erodes into the wall of the stomach. We are not always sure what causes an erosion. It could be how the surgeon did the surgery, or the patient’s eating behavior, or their particular biology. For whatever reason, know that an erosion is RARE. Only 1-2% of patients will ever experience an erosion. If it happens, patients can present in a variety of ways. However, the hallmark is a lack of restriction despite successive Band adjustments (it could also be a leak in the system!). Sometimes people can have abdominal pain, fevers, or even Port-site infections. The doctor can diagnose an erosion with an Upper GI Swallow, but the best test is an EGD. If there is indeed an erosion, then an operation is in order for Band removal.
So remember: an erosion is rare, a significant loss of restriction is the hallmark, and an EGD is the way to diagnose it.
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I have had plenty of Band patients express concern for a Band Erosion after they searched the Internet for answers to some of the quirky sensations they may be having. I want to clarify what a Band Erosion is. Basically, for some reason or variety of reasons, the silicone band around the top part of your stomach erodes into the wall of the stomach. We are not always sure what causes an erosion. It could be how the surgeon did the surgery, or the patient’s eating behavior, or their particular biology. For whatever reason, know that an erosion is RARE. Only 1-2% of patients will ever experience an erosion. If it happens, patients can present in a variety of ways. However, the hallmark is a lack of restriction despite successive Band adjustments (it could also be a leak in the system!). Sometimes people can have abdominal pain, fevers, or even Port-site infections. The doctor can diagnose an erosion with an Upper GI Swallow, but the best test is an EGD. If there is indeed an erosion, then an operation is in order for Band removal.
So remember: an erosion is rare, a significant loss of restriction is the hallmark, and an EGD is the way to diagnose it.
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With Medicare reviewing its coverage criteria for the Vertical Sleeve Gastrectomy, the American Society for Metabolic and Bariatric Surgery, ASMBS, has decided to update its Position Statement. The ASMBS is the society that represents bariatric surgeons and is also responsible for setting up the Centers of Excellence (COE) Program. Up to now, ASMBS held the position that the Sleeve looked “promising” with early and intermediate follow up data, and that the procedure should be studied more, before a final recommendation for its use would be made. The new statement to be released considers the sleeve as a viable alternative surgery option to the Band and Bypass, and that the SLEEVE CRITERIA FOR COVERAGE SHOULD BE THE SAME AS FOR THE BAND AND BYPASS. This is a great step in the right direction for increasing options for surgical weight loss patients. All of these procedures have their distinct advantages and disadvantages. This should help us match an operation more closely to a patients’ expectations for improved health and weight loss.
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Thiamine, Vitamin B1, is an important vitamin to be aware of. Although I don’t usually talk with my patients about this vitamin in terms of ongoing daily supplements, it does deserve some attention.
This vitamin is within the “B complex” family of vitamins and plays a part in sugar and protein breakdown. It is widely abundant in grains and meats, so healthy diets rarely put someone at risk of low levels. General multivitamins almost always have Vitamin B1 in the formulary.
This vitamin can be incredibly crucial when body stores are insufficient. You may have heard of medical terms like “Beriberi” or “Wernicke-Korsakoff Syndrome”, which describe specific symptoms of Thiamine deficiency. Basically, low levels of Thiamine can cause irreversible nerve injury. I have seen this before with traveling bariatric patients, and I can attest to the devastating consequences.
Not to scare you, but if you have chronic vomiting and you are not taking vitamin supplements, you are at high risk of developing Thiamine deficiency.
Low Thiamine can be easily reversed with many over-the-counter supplements. Like always, we will monitor your levels on a regular basis to ensure your safety. But remember your responsibility to maintain a healthy body through daily supplements recommended by our dieticians.
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