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 Fornari, Chandra Prakash Gyawali, Jan Hatlebakk, Scott B. Johnson, Toni Lerut, Lars Lundell, Sandro Mattioli, Hiroto Miwa, Philippe Nafteux & 15 others Taher Omari, John Pandolfino, Roberto 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

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
JournalGut
Volume68
Issue number11
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Guidelines
Patient Selection
Hiatal Hernia
Proton Pump Inhibitors
Endoscopy
Esophageal pH Monitoring
Heartburn
Peptic Esophagitis
Barrett Esophagus
Los Angeles
Esophagitis
Manometry
Barium
Politics
Deglutition
Electric Impedance
Esophagus

Keywords

  • anti-reflux surgery
  • delphi process
  • patient selection

ASJC Scopus subject areas

  • Gastroenterology

Cite this

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

In: Gut, Vol. 68, No. 11, 01.01.2019, p. 1928-1941.

Research output: Contribution to journalArticle

Pauwels, A, Boecxstaens, V, Andrews, CN, Attwood, SE, Berrisford, R, Bisschops, R, Boeckxstaens, GE, Bor, S, Bredenoord, AJ, Cicala, M, Corsetti, M, Fornari, F, Gyawali, CP, Hatlebakk, J, Johnson, SB, Lerut, T, Lundell, L, Mattioli, S, Miwa, H, Nafteux, P, Omari, T, Pandolfino, J, Penagini, R, Rice, TW, Roelandt, P, Rommel, N, Savarino, V, Sifrim, D, Suzuki, H, Tutuian, R, Vanuytsel, T, Vela, MF, Watson, DI, Zerbib, F & 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, vol. 68, no. 11, pp. 1928-1941. https://doi.org/10.1136/gutjnl-2019-318260
Pauwels, Ans ; Boecxstaens, Veerle ; Andrews, Christopher N. ; Attwood, Stephen E. ; Berrisford, Richard ; Bisschops, Raf ; Boeckxstaens, Guy E. ; Bor, Serhat ; Bredenoord, Albert J. ; Cicala, Michele ; Corsetti, Maura ; Fornari, Fernando ; Gyawali, Chandra Prakash ; Hatlebakk, Jan ; Johnson, Scott B. ; Lerut, Toni ; Lundell, Lars ; Mattioli, Sandro ; Miwa, Hiroto ; Nafteux, Philippe ; Omari, Taher ; Pandolfino, John ; Penagini, Roberto ; Rice, Thomas W. ; Roelandt, Philip ; Rommel, Nathalie ; Savarino, Vincenzo ; Sifrim, Daniel ; Suzuki, Hidekazu ; Tutuian, Radu ; Vanuytsel, Tim ; Vela, Marcelo F. ; Watson, David I. ; Zerbib, Frank ; Tack, Jan. / 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). In: Gut. 2019 ; Vol. 68, No. 11. pp. 1928-1941.
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T1 - 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)

AU - Pauwels, Ans

AU - Boecxstaens, Veerle

AU - Andrews, Christopher N.

AU - Attwood, Stephen E.

AU - Berrisford, Richard

AU - Bisschops, Raf

AU - Boeckxstaens, Guy E.

AU - Bor, Serhat

AU - Bredenoord, Albert J.

AU - Cicala, Michele

AU - Corsetti, Maura

AU - Fornari, Fernando

AU - Gyawali, Chandra Prakash

AU - Hatlebakk, Jan

AU - Johnson, Scott B.

AU - Lerut, Toni

AU - Lundell, Lars

AU - Mattioli, Sandro

AU - Miwa, Hiroto

AU - Nafteux, Philippe

AU - Omari, Taher

AU - Pandolfino, John

AU - Penagini, Roberto

AU - Rice, Thomas W.

AU - Roelandt, Philip

AU - Rommel, Nathalie

AU - Savarino, Vincenzo

AU - Sifrim, Daniel

AU - Suzuki, Hidekazu

AU - Tutuian, Radu

AU - Vanuytsel, Tim

AU - Vela, Marcelo F.

AU - Watson, David I.

AU - Zerbib, Frank

AU - Tack, Jan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - anti-reflux surgery

KW - delphi process

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