The Role of High-Resolution Manometry Prior to and Following Antireflux Surgery: The Padova Consensus.

Background: In the last two decades the development of high-resolution manometry (HRM) has changed and revolutionized the diagnostic assessment of patients complain foregut symptoms. The role of HRM before and after antireflux procedure remains unclear, especially in surgical practice, where a clear understanding of esophageal physiology and hiatus anatomy is essential for optimal outcome of antireflux surgery (ARS). Surgeons and gastroenterologists (GIs) agree that assessing patients following antireflux procedures can be challenging. Although endoscopy and barium-swallow can reveal anatomic abnormalities, physiologic information on HRM allowing insight into the cause of eventually recurrent symptoms could be key to clinical decision making.
Method: A multi-disciplinary international working group (14 surgeons and 15 GIs) collaborated to develop consensus on the role of HRM pre- and post- ARS, and to develop a postoperative classification to interpret HRM findings. The method utilized was detailed literature review to develop statements, and the RAND/University of California, Los Angeles Appropriateness Methodology (RAM) to assess agreement with the statements. Only statements with an approval rate >80% or a final ranking with a median score of 7 were accepted in the consensus. The working groups evaluated the role of HRM prior to ARS and the role of HRM following ARS.
Conclusion: This international initiative developed by surgeons and GIs together, summarizes the state of our knowledge of the use of HRM pre- and post-ARS. The Padova Classification was developed to facilitate the interpretation of HRM studies of patients underwent ARS.
Competing Interests: Conflicts of interest : RY: has served as a consultant for Medtronic, Ironwood Pharmaceuticals, Phathom Pharmaceuticals, StatLink MD and Medscape. RY has received research support from Ironwood Pharmaceuticals. RY has served on advisory boards for RJS Mediagnostix with stocks SM: Surgery Advisory Board for Phathom Pharmaceuticals. Consultant for Attract, Endostim, Stella , Data Monitoring and Safety Board for Biostage. JEP: has served as a consultant/speaker for Medtronic, Diversatek, Ironwood Pharmaceuticals, Phathom Pharmaceuticals, Ethicon/J&J, Endogastric Solutions, . JEP has received royalties from shared IP with Medtronic. EVS: has served as speaker for Abbvie, Agave, AGPharma, Alfasigma, Aurora Pharma, CaDiGroup, Celltrion, Dr Falk, EG Stada Group, Fenix Pharma, Fresenius Kabi, Galapagos, Janssen, JB Pharmaceuticals, Innovamedica/Adacyte, Malesci, Mayoly Biohealth, Omega Pharma, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Tillots, Unifarco; has served as consultant for Abbvie, Agave, Alfasigma, Biogen, Bristol-Myers Squibb, Celltrion, Diadema Farmaceutici, Dr. Falk, Fenix Pharma, Fresenius Kabi, Janssen, JB Pharmaceuticals, Merck & Co, Nestlè, Reckitt Benckiser, Regeneron, Sanofi, SILA, Sofar, Synformulas GmbH, Takeda, Unifarco; he received research support from Pfizer, Reckitt Benckiser, SILA, Sofar, Unifarco, Zeta Farmaceutici. CPG has served as a consultant for Medtronic and Diversatek AJ has an institutional consultantship agreement with Medtronic. SR: has served as consultant for Medtronic, Sanofi, Dr Falk Pharma and received research support from Medtronic and Diversatek Healthcare. JK: has served as a consultant/speaker for Allergan, Astra Zeneca, Dr Falk Pharma, Enterra, GE Healthcare, Medtronic, Mylan, Nordmark, Standard Instruments, Takeda FZ, MC, GC, LP, RS, ST: none.
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