Summary of the ICARUS guidelines
| Recommendations | Based on statement(s) |
| Antireflux surgery can be considered for patients with typical symptoms of heartburn, with a good response to proton pump inhibitors (PPIs). | 1 |
| Patients with functional heartburn and patients with eosinophilic oesophagitis are poor candidates for antireflux surgery. | 4, 6 |
| Patients with morbid obesity and patients with substance abuse are not excluded from antireflux surgery. | 9, 11 |
| Endoscopy (during the last year) is mandatory prior to referral for antireflux surgery. There is no need to wean the patient off PPI for endoscopy. | 13, 14 |
| Patients with GORD symptoms and a hiatal hernia, Barrett’s oesophagus or erosive oesophagitis grade B or higher at endoscopy are good candidates for antireflux surgery. | 15, 16b, 18 |
| Patients without erosive oesophagitis are not excluded from antireflux surgery. | 17 |
| There is no need to obtain routine biopsies of the distal oesophagus in patients considered for antireflux surgery. | 19 |
| A barium X-ray should be obtained in patients with suspicion of a hiatal hernia or short oesophagus when considered for antireflux surgery. | 20 |
| Patients with GORD symptoms and a hiatal hernia on X-ray are good candidates for antireflux surgery. | 21, 22 |
| Patients with GORD symptoms and a para-oesophageal hernia on X-ray are good candidates for antireflux surgery in addition to para-oesophageal hernia repair. | 23 |
| A short oesophagus on barium X-ray does not exclude the patient from antireflux surgery. | 24 |
| Oesophageal manometry and oesophageal pH monitoring (±impedance) are mandatory prior to referral for antireflux surgery. The latter is preferentially done off PPI and in patients with NERD. | 25, 30, 31 |
| Patients with normal pH-monitoring off PPI are poor candidates for antireflux surgery. | 32 |
| Response to baclofen does not enhance patient eligibility for antireflux surgery. | 35 |
| There is no need to assess gastric emptying rate in patients considered for antireflux surgery. | 36, 37 |