Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux

Maret-Ouda, John; Wahlin, Karl; El–Serag, Hashem B.; Lagergren, Jesper

doi:10.1001/jama.2017.10981

Cited by 110 publications

(88 citation statements)

References 36 publications

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“…In addition, there is a paucity of data on identifying preoperative factors that predict successful outcomes after MSA. 13 Such data can be used to guide and refine patient selection and improve preoperative patient counseling for the purpose of maximizing successful outcomes.…”

Section: Resultsmentioning

confidence: 99%

Clinical Outcomes and Predictors of Favorable Result after Laparoscopic Magnetic Sphincter Augmentation: Single-Institution Experience with More than 500 Patients

Ayazi

Zheng

Zaidi

et al. 2020

Journal of the American College of Surgeons

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Section: Resultsmentioning

confidence: 99%

Clinical Outcomes and Predictors of Favorable Result after Laparoscopic Magnetic Sphincter Augmentation: Single-Institution Experience with More than 500 Patients

Ayazi

Zheng

Zaidi

et al. 2020

Journal of the American College of Surgeons

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“…The assessment of reflux was based on the long‐term use of anti‐reflux medication, made prospectively through the use of data in a high‐quality and nationwide complete drug register, which allowed for accurate assessment of the outcome and complete follow‐up for several years. Use of anti‐reflux medication as the definition of reflux symptoms allows for an unbiased assessment of reflux and has been used successfully in previous research . This definition does not require subjective reporting by the participants or objective measures and thus allows for a register‐based study approach, enabling a large cohort with long and complete follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…Although the treatment effect observed in this study was immediate and durable, it was insufficient in about half of all patients. For comparison, the proportion of patients requiring anti‐reflux medication after fundoplication is <10% in the first year . However, a direct comparison to treatment results from fundoplication may be inadequate given that the main indication for gastric bypass is obesity; the preoperative work‐up of GERD may be limited, and many patients with GERD undergoing gastric bypass may not have objective findings of reflux.…”

Section: Discussionmentioning

confidence: 99%

Gastric bypass surgery in the treatment of gastro‐oesophageal reflux symptoms

Holmberg

Santoni

Xie

et al. 2019

Aliment Pharmacol Ther

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Background: Gastric bypass is considered an effective treatment of co-existing gastro-oesophageal reflux (GERD) and obesity. Previous studies have had small sample sizes, short follow-up or substantial loss to follow-up. Aim:To assess the long-term risk of remaining/recurring reflux symptoms after gastric bypass. Methods:This was a nationwide cohort study of all adults with preoperative reflux who underwent gastric bypass in Sweden between 2006 and 2015, with complete follow-up through 2016. The outcome was remaining/recurring reflux symptoms, defined as use of proton pump inhibitors or histamine-2 receptor antagonists for >6 months after surgery. Cumulative incidence and risk factors of reflux were assessed with multivariable Poisson regression.Results: Among 2454 participants (81.7% female; mean age: 46.1 years, SD: 9.8 years), who were followed for median 4.6 years (interquartile range: 3.1-6.3 years), reflux recurred in 48.8% (95% confidence interval [95% CI], 46.8-51.0) of participants within 2 years of gastric bypass and remained stable up to 10 years after surgery (yearly change in incidence rate ratio [IRR] of 1.00; 95% CI, 0.99-1.02). Risk factors for recurring reflux were high preoperative dose of anti-reflux medication (IRR 1.77; 95% CI, 1.60-1.96 compared with low dose), older age (IRR 1.12; 95% CI 1.02-1.24 comparing age >50 with <40 years), female sex (IRR 1.28; 95% CI, 1.16-1.42) and comorbidity (IRR 1.26; 95% CI, 1.14-1.39 comparing Charlson Comorbidity Index ≥2 with 0). Conclusions:Reflux symptoms decrease rapidly after gastric bypass, but around half of operated patients require continuous anti-reflux medication. The treatment efficacy of gastric bypass on reflux symptoms might have been overestimated.

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“…Risk factors for recurrence of reflux were female gender, older age and comorbidity. 7 A 5-year follow-up study, the LOTUS trial (Long-Term Usage of Esomeprazole vs Surgery for Treatment of Chronic Gastro-oesophageal Reflux Disease), demonstrated that a standardised laparoscopic Nissen fundoplication performed in expert centres and treatment with esomeprazole had similar outcome results concerning treatment failure rate, although that relief of heartburn was somewhat superior after surgery. The vast majority of patients achieved and remained in remission after 5 years, both in the surgical group as well as in the medical treatment group.…”

Section: What Are the New Findings?mentioning

confidence: 99%

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

Boecxstaens

Andrews

et al. 2019

Gut

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ObjectiveAntireflux 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.DesignWe 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.ResultsPatients 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.ConclusionWith the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.

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Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux

Cited by 110 publications

References 36 publications

Clinical Outcomes and Predictors of Favorable Result after Laparoscopic Magnetic Sphincter Augmentation: Single-Institution Experience with More than 500 Patients

Clinical Outcomes and Predictors of Favorable Result after Laparoscopic Magnetic Sphincter Augmentation: Single-Institution Experience with More than 500 Patients

Gastric bypass surgery in the treatment of gastro‐oesophageal reflux symptoms

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)

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