The first modified Delphi consensus statement on sleeve gastrectomy



Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG.


We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus.


The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett’s esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36–40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE.


A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.

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Sleeve gastrectomy


Gastro-esophageal reflux disease


Barrett’s esophagus


Gastro-esophageal junction


International Federation for the Surgery of Obesity and Metabolic Disorders


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Author information




KKM conceived the idea for this exercise, moderated it, analyzed the results, and wrote large sections of the manuscript. All other authors helped with determining the methodology of the exercise, provided feedback at every stage, took part in the online voting, critically reviewed the draft of the manuscript, and provided robust leadership. All authors have seen the final draft and approve of it.

Corresponding author

Correspondence to Kamal K. Mahawar.

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Dr. Ali Aminian received Grants from Medtronic. Dr. Jacques Himpens receives consultancy fees from Ethicon and Medtronic. Dr. Jaime Ponce receives consultancy fees from Ethicon, Reshape Life sciences, Applied Medical and Allurion and payments for lectures from Gore and Olympus. Prof. Jose M. Balibrea received consultancy fees and payments for lectures from Johnson and Johnson and expert testimony from Beckton Dickinson. Dr. Kiron Bhatia receives ongoing consultancy fees from Apollo Endo-surgery. Dr. Laurent Biertho received consultancy fees from Bausch and Novo Nordisk in addition to ongoing grants from Johnson and Jonson and Medtronic. Dr. Marina Kurian receives payments from Medtronic for lectures including speaking and teaching. Prof. Peterli Ralph receives consultancy fees and grants. Prof. Gerhard Prager receives payments for the development of educational presentations from Medtronic. Prof. Scott Shikora receives consultancy fees from Medtronic and Baxter and is employed by Springer Publishing as Editor-in-Chief of Obesity Surgery Journal. The other authors have no conflicts of interest or financial ties to disclose.

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Mahawar, K.K., Omar, I., Singhal, R. et al. The first modified Delphi consensus statement on sleeve gastrectomy. Surg Endosc (2021).

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  • Bariatric surgery
  • Obesity surgery
  • Sleeve gastrectomy
  • Gastric sleeve