How to select patients for antireflux surgery? the ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery)

Ans Pauwels, Veerle Boecxstaens, Christopher N Andrews, Stephen E Attwood, Richard Berrisford, Raf Bisschops, Guy E Boeckxstaens, Serhat Bor, Albert J Bredenoord, Michele Cicala, Maura Corsetti, Fernando Fornani, Chandra Prakash Gyawali, Jan Hatlebakk, Scott B. Johnson, Toni Lerut, Lars Lundell, Sandro Mattioli, Hiroto Miwa, Phillipe NafteuxTaher Omari, John Pandolfino, Robert Penagini, Thomas W. Rice, Philip Roelandt, Nathalie Rommel, Vincenzo Savarino, Daniel Sifrim, Hidekazu Suzuki, Radu Tutuian, Tim Vanuytsel, Marcelo F. Vela, David I. Watson, Frank Zerbib, Jan Tack

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: Antireflux surgery can be proposed in patients with GORD, especially when proton pump inhibitor (PPI) use leads to incomplete symptom improvement. However, to date, international consensus guidelines on the clinical criteria and additional technical examinations used in patient selection for antireflux surgery are lacking. We aimed at generating key recommendations in the selection of patients for antireflux surgery. Design: We included 35 international experts (gastroenterologists, surgeons and physiologists) in a Delphi process and developed 37 statements that were revised by the Consensus Group, to start the Delphi process. Three voting rounds followed where each statement was presented with the evidence summary. The panel indicated the degree of agreement for the statement. When 80% of the Consensus Group agreed (A+/A) with a statement, this was defined as consensus. All votes were mutually anonymous. Results: Patients with heartburn with a satisfactory response to PPIs, patients with a hiatal hernia (HH), patients with oesophagitis Los Angeles (LA) grade B or higher and patients with Barrett's oesophagus are good candidates for antireflux surgery. An endoscopy prior to antireflux surgery is mandatory and a barium swallow should be performed in patients with suspicion of a HH or short oesophagus. Oesophageal manometry is mandatory to rule out major motility disorders. Finally, oesophageal pH (±impedance) monitoring of PPI is mandatory to select patients for antireflux surgery, if endoscopy is negative for unequivocal reflux oesophagitis. Conclusion: With the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.

Original languageEnglish
Pages (from-to)1928-1941
Number of pages14
JournalGut
Volume68
Issue number11
Early online date2 Aug 2019
DOIs
Publication statusE-pub ahead of print - 2 Aug 2019

Keywords

  • GORD
  • antireflux surgery
  • ICARUS guidelines
  • clinical criteria
  • key recommendations
  • Delphi process
  • anti-reflux surgery
  • patient selection
  • delphi process

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    Pauwels, A., Boecxstaens, V., Andrews, C. N., Attwood, S. E., Berrisford, R., Bisschops, R., Boeckxstaens, G. E., Bor, S., Bredenoord, A. J., Cicala, M., Corsetti, M., Fornani, F., Gyawali, C. P., Hatlebakk, J., Johnson, S. B., Lerut, T., Lundell, L., Mattioli, S., Miwa, H., ... Tack, J. (2019). How to select patients for antireflux surgery? the ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery). Gut, 68(11), 1928-1941. https://doi.org/10.1136/gutjnl-2019-318260