TY - JOUR 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) JF - Gut JO - Gut DO - 10.1136/gutjnl-2019-318260 SP - gutjnl-2019-318260 AU - Ans Pauwels AU - Veerle Boecxstaens AU - Christopher N Andrews AU - Stephen E Attwood AU - Richard Berrisford AU - Raf Bisschops AU - Guy E Boeckxstaens AU - Serhat Bor AU - Albert J Bredenoord AU - Michele Cicala AU - Maura Corsetti AU - Fernando Fornari AU - Chandra Prakash Gyawali AU - Jan Hatlebakk AU - Scott B Johnson AU - Toni Lerut AU - Lars Lundell AU - Sandro Mattioli AU - Hiroto Miwa AU - Philippe Nafteux AU - Taher Omari AU - John Pandolfino AU - Roberto Penagini AU - Thomas W Rice AU - Philip Roelandt AU - Nathalie Rommel AU - Vincenzo Savarino AU - Daniel Sifrim AU - Hidekazu Suzuki AU - Radu Tutuian AU - Tim Vanuytsel AU - Marcelo F Vela AU - David I Watson AU - Frank Zerbib AU - Jan Tack Y1 - 2019/08/02 UR - http://gut.bmj.com/content/early/2019/08/01/gutjnl-2019-318260.abstract 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. ER -