Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 1;281(1):124-135.
doi: 10.1097/SLA.0000000000006297. Epub 2024 Apr 12.

The Role of High-Resolution Manometry Before and Following Antireflux Surgery: The Padova Consensus

Renato Salvador  1 , John E Pandolfino  2 , Mario Costantini  1 , Chandra Prakash Gyawali  3 , Jutta Keller  4 , Sumeet Mittal  5 , Sabine Roman  6 , Edoardo V Savarino  1 , Roger Tatum  7 , Salvatore Tolone  8 , Frank Zerbib  9 , Giovanni Capovilla  1 , Anand Jain  10 , Priya Kathpalia  11 , Luca Provenzano  1 , Rena Yadlapati  12 ; HRM & Foregut Surgery International Working Group
Collaborators, Affiliations

The Role of High-Resolution Manometry Before and Following Antireflux Surgery: The Padova Consensus

Renato Salvador et al. Ann Surg. .

Erratum in

Abstract

Background: In the last 2 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, physiological information on HRM allowing insight into the cause of eventually recurrent symptoms could be key to clinical decision-making.

Methods: A multidisciplinary international working group (14 surgeons and 15 GIs) collaborated to develop consensus on the role of HRM pre-ARS 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 before ARS and the role of HRM following ARS.

Conclusions: This international initiative developed by surgeons and GIs together, summarizes the state of our knowledge of the use of HRM pre-ARS and post-ARS. The Padova Classification was developed to facilitate the interpretation of HRM studies of patients underwent ARS.

PubMed Disclaimer

Conflict of interest statement

R.Y.: has served as a consultant for Medtronic, Ironwood Pharmaceuticals, Phathom Pharmaceuticals, StatLink MD, and Medscape; he has received research support from Ironwood Pharmaceuticals; and has served on advisory boards for RJS Mediagnostix with stocks. S.M.: Surgery Advisory Board for Phathom Pharmaceuticals; onsultant for Attract, Endostim, Stella; Data Monitoring and Safety Board for Biostage. J.E.P.: has served as a consultant/speaker for Medtronic, Diversatek, Ironwood Pharmaceuticals, Phathom Pharmaceuticals, Ethicon/J&J, Endogastric Solutions. J.E.P. has received royalties from shared IP with Medtronic. E.V.S.: 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. C.P.G. has served as a consultant for Medtronic and Diversatek. A.J. has an institutional consultantship agreement with Medtronic. S.R.: has served as consultant for Medtronic, Sanofi, Dr Falk Pharma and received research support from Medtronic and Diversatek Healthcare. J.K.: has served as a consultant/speaker for Allergan, Astra Zeneca, Dr Falk Pharma, Enterra, GE Healthcare, Medtronic, Mylan, Nordmark, Standard Instruments, Takeda. The remaining authors report no conflicts of interest.

Similar articles

See all similar articles

Cited by

References

    1. Khajanchee YS, Hong D, Hansen PD, Swanström LL. Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results. The American journal of surgery. 2004;187:599–603. - PubMed
    1. Peters JH, DeMeester Tr, Crookes P, et al. the treatment of gastroesophageal reflux disease with laparoscopic nissen fundoplication: prospective evaluation of 100 patients with “typical” symptoms. Ann Surg 1998;228:40–50. - PMC - PubMed
    1. Anvari M, Allen C. Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg 2003;196:51–7. - PubMed
    1. Wilkerson PM, Stratford J, Jones l, et al. a poor response to proton pump inhibition is not a contraindication for laparoscopic antireflux surgery for gastro esophageal reflux disease. Surg Endosc 2005;19:1272–7. - PubMed
    1. Pauwels A, Boecxstaens V, Anews CN, et al. How to select patients for antireflux surgery? the ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery). Gut. 2019;68:1928–1941. - PubMed

Publication types