Antireflux Surgery Selection Guidelines (2019)

International Society for Diseases of the Esophagus

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

September 03, 2019

In August 2019, through a multidisciplinary group supported by the International Society for Diseases of the Esophagus (ISDE), the ICARUS (International Consensus Regarding Preoperative Examinations and Clinical Characteristics Assessment to Select Adult Patients for Antireflux Surgery) guidelines on the selection of patients for antireflux surgery were published.[1,2]

Good candidates for antireflux surgery include the following:

  • Patients with heartburn who demonstrate a satisfactory response to proton-pump inhibitors (PPIs)

  • Patients with a hiatal hernia

  • Patients with esophagitis of Los Angeles grade B or higher

  • Patients with Barrett esophagus

Poor candidates for antireflux surgery include patients with functional heartburn or eosinophilic esophagitis.

All candidates for antireflux surgery should first undergo endoscopy.

Additionally, a barium swallow should be administered to patients suspected of having a hiatal hernia or short esophagus.

Esophageal manometry is a required modality for ruling out major motility disorders.

If reflux esophagitis is not unequivocally revealed through endoscopy, the patient should, prior to antireflux surgery referral, undergo esophageal pH monitoring (with or without impedance monitoring) while abstaining from PPIs.

Gastric emptying does not need to be assessed in patients being considered for antireflux surgery.

For more information, please go to Gastroesophageal Reflux Disease.

For more Clinical Practice Guidelines, please go to Guidelines.

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