Evaluation of ICARUS Guidelines and Recommendations Not Supported by Randomized Controlled Trials.

The ICARUS guidelines are a systematic review and Delphi process that provide recommendations in the treatment and management of patients with gastroesophageal reflux disease (GERD). Many of the recommendations were supported by randomized trials; some were not. This study assesses guidelines with limited evidence and weak endorsement. Four ICARUS guidelines were chosen: the role of fundoplication for patients with BMI > 35, regurgitation, chest pain, and extra-esophageal symptoms. A multicenter database of patients undergoing fundoplication surgery for GERD between 2015 and 2020 was used. Outcomes assessed were anatomic failure and symptom recurrence. Multivariable regression was performed. Five institutions performed a fundoplication on 461 patients for GERD with a median of follow-up of 14.7 months (IQR 14.2). On multivariate analysis, patients with the chosen pre-operative comorbidities achieved comparable post-operative benefits. Patients with a BMI > 35 were not more likely to experience anatomic failure. Patients with pre-operative regurgitation had similar symptom recurrence rates to those without. Patients with non-cardiac chest pain had comparable rates of symptom recurrence to those without. Reporting a pre-operative chronic cough attributable to reflux was not associated with higher rates of post-operative symptom recurrence. Among the ICARUS guidelines and recommendations, a small proportion was lacking evidence at low risk for bias and endorsement. The results of this multicenter study evaluated outcomes of patients with various pre-operative conditions: BMI > 35, chest pain attributable to reflux, extra-esophageal symptoms attributable to reflux, and regurgitation. Our findings endorse patients with these characteristics as candidates for anti-reflux surgery. © 2023. The Society for Surgery of the Alimentary Tract.

Citation

Cassandra Mohr, Hailie Ciomperlik, Naila Dhanani, Oscar A Olavarria, Craig Hannon, William Hope, Scott Roth, Mike K Liang, Julie L Holihan. Evaluation of ICARUS Guidelines and Recommendations Not Supported by Randomized Controlled Trials. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2023 Feb;27(2):390-397

Mesh Tags

PMID: 36650419

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