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

Autor: Mohr C; Department of Surgery, McGovern Medical School, Houston, TX, USA. cassandramohr@utexas.edu.; Department of Surgery, Lyndon B. Johnson Hospital, 5656 Kelley St, Houston, TX, 77026, USA. cassandramohr@utexas.edu., Ciomperlik H; Department of Surgery, McGovern Medical School, Houston, TX, USA., Dhanani N; Department of Surgery, McGovern Medical School, Houston, TX, USA., Olavarria OA; Department of Surgery, McGovern Medical School, Houston, TX, USA., Hannon C; Department of Surgery, McGovern Medical School, Houston, TX, USA., Hope W; Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA., Roth S; Department of Surgery, University of Kentucky, Lexington, KY, USA., Liang MK; Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, Houston, TX, USA., Holihan JL; Department of Surgery, McGovern Medical School, Houston, TX, USA.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2023 Feb; Vol. 27 (2), pp. 390-397. Date of Electronic Publication: 2023 Jan 17.
DOI: 10.1007/s11605-023-05590-3
Abstrakt: Background: 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.
Methods: 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.
Results: 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.
Discussion: 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.)
Databáze: MEDLINE
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