Results of the ARROW survey of anti-reflux practice in the United Kingdom
Author
ARROW Study GroupWriting Group
Walker, Robert
Currie, Andrew
Wiggins, Tom
Markar, Sheraz R
Blencowe, Natalie S
Underwood, Tim
Hollyman, Marianne
Publication date
2023-04-05
Metadata
Show full item recordAbstract
Gastro-esophageal reflux disease (GERD) is a common, significant health burden. United Kingdom guidance states that surgery should be considered for patients with a diagnosis of GERD not suitable for long-term acid suppression. There is no consensus on many aspects of patient pathways and optimal surgical technique, and an absence of information on how patients are currently selected for surgery. Further detail on the delivery of anti-reflux surgery (ARS) is required. A United Kingdom-wide survey was designed to gather surgeon opinion regarding pre-, peri- and post-operative practice of ARS. Responses were received from 155 surgeons at 57 institutions. Most agreed that endoscopy (99%), 24-hour pH monitoring (83%) and esophageal manometry (83%) were essential investigations prior to surgery. Of 57 units, 30 (53%) had access to a multidisciplinary team to discuss cases; case-loads were higher in those units (median 50 vs. 30, P < 0.024). The most popular form of fundoplication was a Nissen posterior 360° (75% of surgeons), followed by a posterior 270° Toupet (48%). Only seven surgeons stated they had no upper limit of body mass index prior to surgery. A total of 46% of respondents maintain a database of their practice and less than a fifth routinely record quality of life scores before (19%) or after (14%) surgery. While there are areas of consensus, a lack of evidence to support workup, intervention and outcome evaluation is reflected in the variability of practice. ARS patients are not receiving the same level of evidence-based care as other patient groups.Citation
Dis Esophagus. 2023 Apr 5:doad021. doi: 10.1093/dote/doad021. Online ahead of print.Type
ArticlePMID
37019630Journal
Diseases of the EsophagusPublisher
Oxford University Pressae974a485f413a2113503eed53cd6c53
10.1093/dote/doad021