INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Ain Shams School of Medicine Cairo Egypt

All India Institute of Medical Sciences New Delhi India

Apollo Hospitals New Delhi India

Austin Health Melbourne Australia

Bariatric Unit South Tyneside and Sunderland NHS Trust Sunderland UK

Birmingham Heartlands Hospital University Hospital Birmingham NHS Foundation Trust Birmingham UK

Bouchard Private Hospital Elsan Marseille France

Brigham and Women's Hospital Harvard Medical School Boston USA

Castelfranco Montebelluna Hospitals Montebelluna Italy

Centro Médico Puerta de Hierro Andares Zapopan Mexico

CHI Memorial Hospital Chattanooga TN USA

CHIREC Delta Hospital Brussels Belgium

Cleveland Clinic Cleveland USA

Cleveland Clinic Weston FL USA

Concord Repatriation General Hospital Sydney Australia

Department for Metabolic Surgery Sana Klinikum Offenbach Offenbach Germany

Diakonissen and Wehrle Private Hospital Salzburg Austria

Dutch Obesity Clinic The Hague Netherlands

East Carolina University Greenville USA

Emek Medical Center Afula Israel

Faculty of Health Sciences and Wellbeing University of Sunderland Sunderland UK

Flinders University Adelaide South Australia Australia

Franciscus Gasthuis Rotterdam Rotterdam Netherlands

GBMC at Jordan Hospital Amman Jordan

Gem Hospital Chennai India

Hospital Clínic de Barcelona Barcelona Spain

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico Mexico

Istinye University Istanbul Turkey

Jorge Manuel Nunes dos Santos Lisbon Portugal

KF University Medical Center Nur Sultan Kazakhstan

Kuwait University Kuwait Kuwait

Makassed General Hospital Beirut Lebanon

Medical University of Vienna Vienna Austria

Medical University of Warsaw Warsaw Poland

Mediclinic Parkview Dubayy United Arab Emirates

National University Hospital Singapore Singapore

New Life Center Guatemala Guatemala

New York University School of Medicine New York USA

Nini Hospital Tripoli Lebanon

OB Klinika Center for Treatment of Obesity and Metabolic Disorders Prague Czech Republic

Oregon Health and Science University Portland USA

Oslo University Hospital Oslo Norway

Phoenix Health London UK

Polyclinique Lyon Nord Rillieux la Pape France

Quebec Heart and Lung Institute Laval University Quebec Canada

The 1st Affiliated Hospital of Jinan University Guangzhou China

University Hospital Basel Basel Switzerland

University Hospitals Coventry and Warwickshire NHS Trust Coventry UK

University of Illinois Chicago USA

University of Naples Naples Italy

Valiant Clinic Dubayy United Arab Emirates

Yotsuya Medical Cube Tokyo Japan

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