Journal Article

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)

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

2019

Overview

ObjectiveAntireflux 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.DesignWe 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.ResultsPatients 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.ConclusionWith the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD
• Subject: Acids / anti-reflux surgery / Barium / Barrett's esophagus / Clinical medicine / Comorbidity / delphi process / Endoscopy / Esophagitis / Esophagus / Experts / Gastroenterology / Gastroesophageal reflux / Hepatology / Hernia / Laparoscopy / Literature reviews / Medical treatment / Oesophagus / patient selection / Patients / Pediatrics / Proton pump inhibitors / Surgery / Working groups