Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Surg Endosc. 2024 Jul;38(7):3992-3998. doi: 10.1007/s00464-024-10910-y. Epub 2024 Jun 6.
Most patients undergoing anti-reflux surgery (ARS) have a history of preoperative proton pump inhibitor (PPI) use. It is well-established that ARS is effective in restoring the anti-reflux barrier, eliminating the ongoing need for costly PPIs. Current literature lacks objective evidence supporting an optimal postoperative PPI cessation or weaning strategy, leading to wide practice variations. We sought to objectively gauge current practice and opinion surrounding the postoperative management of PPIs among expert foregut surgeons and gastroenterologists in the United States.
We created a survey of postoperative PPI management protocols, with an emphasis on discontinuation and timing of PPI cessation, and aimed to determine what factors played a role in the decision-making. An electronic survey tool (Qualtrics XM, Qualtrics, Provo, UT) was used to distribute the survey and to record the responses anonymously for a period of three months.
The survey was viewed 2658 times by 373 institutions and shared with 644 members. In total, 121 respondents participated in the survey and 111 were surgeons (92%). Fifty respondents (42%) always discontinue PPIs immediately after ARS. Of the remaining 70 respondents (58%), 46% always wean or taper PPIs postoperatively and 47% wean or taper them selectively. The majority (92%) of practitioners taper within a 3-month period postoperatively. Five respondents never discontinue PPIs after ARS. Overall, only 23 respondents (19%) stated their protocol is based on medical literature or evidence-based medicine. Instead, decision-making is primarily based on anecdotal evidence/personal preference (42%, n = 50) or prior training/mentors (39%, n = 47).
There are two major protocols used for PPI discontinuation after ARS: Nearly half of providers abruptly stop PPIs, while just over half gradually tapers them, most often in the early postoperative period. These decisions are primarily driven by institutional practices and personal preferences, underscoring the need for evidence-based recommendations.
大多数接受抗反流手术（ARS）的患者都有术前质子泵抑制剂（PPI）使用史。众所周知，ARS 可有效恢复抗反流屏障，消除对昂贵 PPI 的持续需求。目前的文献缺乏支持术后 PPI 停药或逐渐减少策略的客观证据，导致实践差异较大。我们旨在客观评估美国专家前肠外科医生和胃肠病学家对术后 PPI 管理的当前实践和意见。
我们创建了一项关于术后 PPI 管理方案的调查，重点关注停药和停药时间，并旨在确定哪些因素在决策中起作用。使用电子调查工具（Qualtrics XM，Qualtrics，Provo，UT）在三个月的时间内分发调查并匿名记录回复。
该调查被 373 个机构查看了 2658 次，并与 644 名成员共享。共有 121 名受访者参与了调查，其中 111 名是外科医生（92%）。50 名受访者（42%）在 ARS 后立即停止使用 PPI。其余 70 名受访者（58%）中，46%始终在术后逐渐减少或减少 PPI，47%有选择地减少或减少 PPI。大多数（92%）从业者在术后 3 个月内逐渐减少。有 5 名受访者在 ARS 后从不停止使用 PPI。总体而言，只有 23 名受访者（19%）表示他们的方案基于医学文献或循证医学。相反，决策主要基于传闻证据/个人偏好（42%，n=50）或之前的培训/导师（39%，n=47）。
ARS 后 PPI 停药有两种主要方案：近一半的提供者突然停止使用 PPI，而超过一半的提供者逐渐减少 PPI，大多数在术后早期。这些决定主要由机构实践和个人偏好驱动，突出了对循证建议的需求。
