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*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)78-87.e2
JournalGastrointestinal endoscopy
Issue number1
StatePublished - Jul 2020

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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