The Role of High-Resolution Manometry Before and Following Antireflux Surgery: The Padova Consensus.

Background

In the last 2 decades the development of high-resolution manometry (HRM) has changed and revolutionized the diagnostic assessment of patients complain foregut symptoms. The role of HRM before and after antireflux procedure remains unclear, especially in surgical practice, where a clear understanding of esophageal physiology and hiatus anatomy is essential for optimal outcome of antireflux surgery (ARS). Surgeons and gastroenterologists (GIs) agree that assessing patients following antireflux procedures can be challenging. Although endoscopy and barium-swallow can reveal anatomic abnormalities, physiological information on HRM allowing insight into the cause of eventually recurrent symptoms could be key to clinical decision-making.

Methods

A multidisciplinary international working group (14 surgeons and 15 GIs) collaborated to develop consensus on the role of HRM pre-ARS and post-ARS, and to develop a postoperative classification to interpret HRM findings. The method utilized was detailed literature review to develop statements, and the RAND/University of California, Los Angeles Appropriateness Methodology (RAM) to assess agreement with the statements. Only statements with an approval rate >80% or a final ranking with a median score of 7 were accepted in the consensus. The working groups evaluated the role of HRM before ARS and the role of HRM following ARS.

Conclusions

This international initiative developed by surgeons and GIs together, summarizes the state of our knowledge of the use of HRM pre-ARS and post-ARS. The Padova Classification was developed to facilitate the interpretation of HRM studies of patients underwent ARS.

COI Statement

R.Y.: has served as a consultant for Medtronic, Ironwood Pharmaceuticals, Phathom Pharmaceuticals, StatLink MD, and Medscape; he has received research support from Ironwood Pharmaceuticals; and has served on advisory boards for RJS Mediagnostix with stocks. S.M.: Surgery Advisory Board for Phathom Pharmaceuticals; onsultant for Attract, Endostim, Stella; Data Monitoring and Safety Board for Biostage. J.E.P.: has served as a consultant/speaker for Medtronic, Diversatek, Ironwood Pharmaceuticals, Phathom Pharmaceuticals, Ethicon/J&J, Endogastric Solutions. J.E.P. has received royalties from shared IP with Medtronic. E.V.S.: has served as speaker for Abbvie, Agave, AGPharma, Alfasigma, Aurora Pharma, CaDiGroup, Celltrion, Dr Falk, EG Stada Group, Fenix Pharma, Fresenius Kabi, Galapagos, Janssen, JB Pharmaceuticals, Innovamedica/Adacyte, Malesci, Mayoly Biohealth, Omega Pharma, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Tillots, Unifarco; has served as consultant for Abbvie, Agave, Alfasigma, Biogen, Bristol-Myers Squibb, Celltrion, Diadema Farmaceutici, Dr. Falk, Fenix Pharma, Fresenius Kabi, Janssen, JB Pharmaceuticals, Merck & Co, Nestlè, Reckitt Benckiser, Regeneron, Sanofi, SILA, Sofar, Synformulas GmbH, Takeda, Unifarco; he received research support from Pfizer, Reckitt Benckiser, SILA, Sofar, Unifarco, Zeta Farmaceutici. C.P.G. has served as a consultant for Medtronic and Diversatek. A.J. has an institutional consultantship agreement with Medtronic. S.R.: has served as consultant for Medtronic, Sanofi, Dr Falk Pharma and received research support from Medtronic and Diversatek Healthcare. J.K.: has served as a consultant/speaker for Allergan, Astra Zeneca, Dr Falk Pharma, Enterra, GE Healthcare, Medtronic, Mylan, Nordmark, Standard Instruments, Takeda. The remaining authors report no conflicts of interest.

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