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

Area of Science:

• Gastroenterology and Surgical Innovation
• Evidence-Based Medicine in Reflux Management

Background:

• The ICARUS guidelines offer recommendations for gastroesophageal reflux disease (GERD) treatment, based on systematic reviews and Delphi processes.
• Some recommendations lack robust evidence and strong endorsement, necessitating further clinical validation.
• This study evaluates the efficacy of anti-reflux surgery for specific patient profiles identified by the ICARUS guidelines.

Approach:

• A multicenter database of 461 patients undergoing fundoplication for GERD (2015-2020) was analyzed.
• Outcomes including anatomic failure and symptom recurrence were assessed using multivariable regression.
• Specific pre-operative conditions evaluated were BMI > 35, regurgitation, chest pain, and extra-esophageal symptoms.

Key Points:

• Fundoplication demonstrated comparable post-operative benefits across patients with pre-operative comorbidities.
• Higher BMI ( > 35) did not correlate with increased anatomic failure rates.
• Pre-operative regurgitation, non-cardiac chest pain, or chronic cough did not lead to higher symptom recurrence rates.

Conclusions:

• The study supports the use of anti-reflux surgery for GERD patients with characteristics like obesity, regurgitation, chest pain, and extra-esophageal symptoms.
• Findings validate the application of ICARUS guidelines, particularly for cases with initially limited evidence.
• This research reinforces the candidacy of these patient groups for successful anti-reflux surgical interventions.