• Renato Salvador, John E Pandolfino, Mario Costantini, C Prakash Gyawali, Jutta Keller, Sumeet Mittal, Sabine Roman, Edoardo Vincenzo Savarino, Roger Tatum, Salvatore Tolone, Frank Zerbib, Giovanni Capovilla, Anand Jain, Priya Kathpalia, Luca Provenzano, Rena Yadlapati, and HRM and Foregut Surgery International Working group.
• Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy.
• Ann. Surg. 2024 Apr 12.

BackgroundIn 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.MethodA 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.ConclusionThis 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.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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