Surgical and endoscopic management options for patients with GERD based on proton pump inhibitor symptom response: recommendations from an expert U.S. panel

Andrew J Gawron; Reginald Bell; Barham K Abu Dayyeh; F P Buckley; Kenneth Chang; Christy M Dunst; Steven A Edmundowicz; Blair Jobe; John C Lipham; Dan Lister; Marcia Irene Canto; Michael S Smith; Anthony A Starpoli; George Triadafilopoulos; Thomas J Watson; Erik Wilson; John E Pandolfino; Alexander Kaizer; Zoe Van De Voorde; Rena Yadlapati

doi:10.1016/j.gie.2020.01.037

Surgical and endoscopic management options for patients with GERD based on proton pump inhibitor symptom response: recommendations from an expert U.S. panel

Gastrointest Endosc. 2020 Jul;92(1):78-87.e2. doi: 10.1016/j.gie.2020.01.037. Epub 2020 Jan 31.

Authors

Andrew J Gawron¹, Reginald Bell², Barham K Abu Dayyeh³, F P Buckley⁴, Kenneth Chang⁵, Christy M Dunst⁶, Steven A Edmundowicz⁷, Blair Jobe⁸, John C Lipham⁹, Dan Lister¹⁰, Marcia Irene Canto¹¹, Michael S Smith¹², Anthony A Starpoli¹³, George Triadafilopoulos¹⁴, Thomas J Watson¹⁵, Erik Wilson¹⁶, John E Pandolfino¹⁷, Alexander Kaizer⁷, Zoe Van De Voorde⁷, Rena Yadlapati¹⁸

Affiliations

¹ University of Utah and Salt Lake City VA Medical Center, Salt Lake City, Utah, USA.
² Institute of Esophageal and Reflux Surgery, Denver, Colorado, USA.
³ Mayo Clinic, Rochester, Minnesota, USA.
⁴ University of Texas- Dell Medical School, Austin, Texas, USA.
⁵ University of California Irvine, Irvine, California, USA.
⁶ The Oregon Clinic, Portland, Oregon, USA.
⁷ University of Colorado, Aurora, Colorado, USA.
⁸ Allegheny Health Network, Greensburg, Pennsylvania, USA.
⁹ University of Southern California, Los Angeles, California, USA.
¹⁰ Arkansas Heartburn Treatment Center, Heber Springs, Arkansas, USA.
¹¹ Johns Hopkins University, Baltimore, Maryland, USA.
¹² Mount Sinai West & Mount Sinai Morningside Hospitals, New York, New York, USA.
¹³ NYU Langone Medical Center & Northwell Lenox Hill Hospital, New York, New York, USA.
¹⁴ Stanford University, Stanford, California, USA.
¹⁵ MedStar Georgetown University Hospital, Washington, DC, USA.
¹⁶ University of Texas McGovern Medical School, Houston, Texas, USA.
¹⁷ Northwestern University, Chicago, Illinois, USA.
¹⁸ University of Colorado, Aurora, Colorado, USA; University of California San Diego, San Diego, California, USA.

Abstract

Background and aims: The objective of this study was to examine expert opinion and agreement on the treatment of distinct GERD profiles from surgical and therapeutic endoscopy perspectives.

Methods: We used the RAND/University of California, Los Angeles Appropriateness Method over 6 months (July 2018 to January 2019) to assess the appropriateness of antireflux interventions among foregut surgeons and therapeutic gastroenterologists. Patients with primary atypical or extraesophageal symptoms were not considered. Patient scenarios were grouped according to their symptom response to proton pump inhibitor (PPI) therapy. The primary outcome was appropriateness of an intervention.

Results: Antireflux surgery with laparoscopic fundoplication (LF) and magnetic sphincter augmentation (MSA) were ranked as appropriate for all complete and partial PPI responder scenarios. Transoral incisionless fundoplication was ranked as appropriate in complete and partial PPI responders without a hiatal hernia. Radiofrequency energy was not ranked as appropriate for complete or partial responders. There was lack of agreement between surgery and interventional gastroenterology groups on the appropriateness of LF and MSA for PPI nonresponders. Rankings for PPI nonresponders were similar when results from impedance-pH testing on PPI therapy were available, except that LF and MSA were not ranked as appropriate for PPI nonresponders if the impedance-pH study was negative.

Conclusions: This work highlights areas of agreement for invasive therapeutic approaches for GERD and provides impetus for further interdisciplinary collaboration and trials to compare and generate novel and effective treatment approaches and care pathways, including the role of impedance-pH testing in PPI nonresponders.

MeSH terms

Adult
Aged
Endoscopy
Endoscopy, Gastrointestinal
Female
Fundoplication
Gastroesophageal Reflux* / drug therapy
Gastroesophageal Reflux* / surgery
Humans
Laparoscopy*
Los Angeles
Male
Middle Aged
Proton Pump Inhibitors / therapeutic use
Treatment Outcome

Substances

Proton Pump Inhibitors

Abstract

MeSH terms

Substances

Grants and funding