Preoperative diagnostic workup before antireflux surgery: An evidence and experience-based consensus of the esophageal diagnostic advisory panel

Blair A. Jobe, Joel E. Richter, Toshitaka Hoppo, Jeffrey H. Peters, Reginald Bell, William C. Dengler, Kenneth Devault, Ronnie Fass, C. Prakash Gyawali, Peter J. Kahrilas, Brian E. Lacy, John E. Pandolfino, Marco G. Patti, Lee L. Swanstrom, Ashwin A. Kurian, Marcelo F. Vela, Michael Vaezi, Tom R. Demeester

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Background Gastroesophageal reflux disease (GERD) is a very prevalent disorder. Medical therapy improves symptoms in some but not all patients. Antireflux surgery is an excellent option for patients with persistent symptoms such as regurgitation, as well as for those with complete symptomatic resolution on acid-suppressive therapy. However, proper patient selection is critical to achieve excellent outcomes. Study Design A panel of experts was assembled to review data and personal experience with regard to appropriate preoperative evaluation for antireflux surgery and to construct an evidence and experience-based consensus that has practical application. Results The presence of reflux symptoms alone is not sufficient to support a diagnosis of GERD before antireflux surgery. Esophageal objective testing is required to physiologically and anatomically evaluate the presence and severity of GERD in all patients being considered for surgical intervention. It is critical to document the presence of abnormal distal esophageal acid exposure, especially when antireflux surgery is considered, and reflux-related symptoms should be severe enough to outweigh the potential side effects of fundoplication. Each testing modality has a specific role in the diagnosis and workup of GERD, and no single test alone can provide the entire clinical picture. Results of testing are combined to document the presence and extent of the disease and assist in planning the operative approach. Conclusions Currently, upper endoscopy, barium esophagram, pH testing, and manometry are required for preoperative workup for antireflux surgery. Additional studies with long-term follow-up are required to evaluate the diagnostic and therapeutic benefit of new technologies, such as oropharyngeal pH testing, multichannel intraluminal impedance, and hypopharyngeal multichannel intraluminal impedance, in the context of patient selection for antireflux surgery.

Original languageEnglish (US)
Pages (from-to)586-597
Number of pages12
JournalJournal of the American College of Surgeons
Volume217
Issue number4
DOIs
StatePublished - Oct 2013
Externally publishedYes

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Gastroesophageal Reflux
Electric Impedance
Patient Selection
Fundoplication
Acids
Manometry
Barium
Endoscopy
Therapeutics
Technology

ASJC Scopus subject areas

  • Surgery

Cite this

Preoperative diagnostic workup before antireflux surgery : An evidence and experience-based consensus of the esophageal diagnostic advisory panel. / Jobe, Blair A.; Richter, Joel E.; Hoppo, Toshitaka; Peters, Jeffrey H.; Bell, Reginald; Dengler, William C.; Devault, Kenneth; Fass, Ronnie; Gyawali, C. Prakash; Kahrilas, Peter J.; Lacy, Brian E.; Pandolfino, John E.; Patti, Marco G.; Swanstrom, Lee L.; Kurian, Ashwin A.; Vela, Marcelo F.; Vaezi, Michael; Demeester, Tom R.

In: Journal of the American College of Surgeons, Vol. 217, No. 4, 10.2013, p. 586-597.

Research output: Contribution to journalArticle

Jobe, BA, Richter, JE, Hoppo, T, Peters, JH, Bell, R, Dengler, WC, Devault, K, Fass, R, Gyawali, CP, Kahrilas, PJ, Lacy, BE, Pandolfino, JE, Patti, MG, Swanstrom, LL, Kurian, AA, Vela, MF, Vaezi, M & Demeester, TR 2013, 'Preoperative diagnostic workup before antireflux surgery: An evidence and experience-based consensus of the esophageal diagnostic advisory panel', Journal of the American College of Surgeons, vol. 217, no. 4, pp. 586-597. https://doi.org/10.1016/j.jamcollsurg.2013.05.023
Jobe, Blair A. ; Richter, Joel E. ; Hoppo, Toshitaka ; Peters, Jeffrey H. ; Bell, Reginald ; Dengler, William C. ; Devault, Kenneth ; Fass, Ronnie ; Gyawali, C. Prakash ; Kahrilas, Peter J. ; Lacy, Brian E. ; Pandolfino, John E. ; Patti, Marco G. ; Swanstrom, Lee L. ; Kurian, Ashwin A. ; Vela, Marcelo F. ; Vaezi, Michael ; Demeester, Tom R. / Preoperative diagnostic workup before antireflux surgery : An evidence and experience-based consensus of the esophageal diagnostic advisory panel. In: Journal of the American College of Surgeons. 2013 ; Vol. 217, No. 4. pp. 586-597.
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abstract = "Background Gastroesophageal reflux disease (GERD) is a very prevalent disorder. Medical therapy improves symptoms in some but not all patients. Antireflux surgery is an excellent option for patients with persistent symptoms such as regurgitation, as well as for those with complete symptomatic resolution on acid-suppressive therapy. However, proper patient selection is critical to achieve excellent outcomes. Study Design A panel of experts was assembled to review data and personal experience with regard to appropriate preoperative evaluation for antireflux surgery and to construct an evidence and experience-based consensus that has practical application. Results The presence of reflux symptoms alone is not sufficient to support a diagnosis of GERD before antireflux surgery. Esophageal objective testing is required to physiologically and anatomically evaluate the presence and severity of GERD in all patients being considered for surgical intervention. It is critical to document the presence of abnormal distal esophageal acid exposure, especially when antireflux surgery is considered, and reflux-related symptoms should be severe enough to outweigh the potential side effects of fundoplication. Each testing modality has a specific role in the diagnosis and workup of GERD, and no single test alone can provide the entire clinical picture. Results of testing are combined to document the presence and extent of the disease and assist in planning the operative approach. Conclusions Currently, upper endoscopy, barium esophagram, pH testing, and manometry are required for preoperative workup for antireflux surgery. Additional studies with long-term follow-up are required to evaluate the diagnostic and therapeutic benefit of new technologies, such as oropharyngeal pH testing, multichannel intraluminal impedance, and hypopharyngeal multichannel intraluminal impedance, in the context of patient selection for antireflux surgery.",
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T1 - Preoperative diagnostic workup before antireflux surgery

T2 - An evidence and experience-based consensus of the esophageal diagnostic advisory panel

AU - Jobe, Blair A.

AU - Richter, Joel E.

AU - Hoppo, Toshitaka

AU - Peters, Jeffrey H.

AU - Bell, Reginald

AU - Dengler, William C.

AU - Devault, Kenneth

AU - Fass, Ronnie

AU - Gyawali, C. Prakash

AU - Kahrilas, Peter J.

AU - Lacy, Brian E.

AU - Pandolfino, John E.

AU - Patti, Marco G.

AU - Swanstrom, Lee L.

AU - Kurian, Ashwin A.

AU - Vela, Marcelo F.

AU - Vaezi, Michael

AU - Demeester, Tom R.

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N2 - Background Gastroesophageal reflux disease (GERD) is a very prevalent disorder. Medical therapy improves symptoms in some but not all patients. Antireflux surgery is an excellent option for patients with persistent symptoms such as regurgitation, as well as for those with complete symptomatic resolution on acid-suppressive therapy. However, proper patient selection is critical to achieve excellent outcomes. Study Design A panel of experts was assembled to review data and personal experience with regard to appropriate preoperative evaluation for antireflux surgery and to construct an evidence and experience-based consensus that has practical application. Results The presence of reflux symptoms alone is not sufficient to support a diagnosis of GERD before antireflux surgery. Esophageal objective testing is required to physiologically and anatomically evaluate the presence and severity of GERD in all patients being considered for surgical intervention. It is critical to document the presence of abnormal distal esophageal acid exposure, especially when antireflux surgery is considered, and reflux-related symptoms should be severe enough to outweigh the potential side effects of fundoplication. Each testing modality has a specific role in the diagnosis and workup of GERD, and no single test alone can provide the entire clinical picture. Results of testing are combined to document the presence and extent of the disease and assist in planning the operative approach. Conclusions Currently, upper endoscopy, barium esophagram, pH testing, and manometry are required for preoperative workup for antireflux surgery. Additional studies with long-term follow-up are required to evaluate the diagnostic and therapeutic benefit of new technologies, such as oropharyngeal pH testing, multichannel intraluminal impedance, and hypopharyngeal multichannel intraluminal impedance, in the context of patient selection for antireflux surgery.

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