Lyon Consensus 2.0 vs Conventional Surgical Criteria for Predicting Favorable Outcomes After Antireflux Surgery

BACKGROUND: Lyon Consensus 2.0 revised the criteria for conclusive GERD by including grade B esophagitis and requiring abnormal acid exposure on at least 2 monitoring days for physiologic confirmation. Whether these criteria improve selection of patients for antireflux surgery (ARS) remains uncertain. We compared Lyon 2.0 with conventional surgical criteria for their association with favorable postoperative outcomes. STUDY DESIGN: Patients undergoing ARS after preoperative endoscopy and 48-hour wireless pH monitoring were classified according to Lyon 2.0 criteria and conventional surgical criteria, defined as grade C/D esophagitis or an abnormal DeMeester score on ≥1 monitoring day. Favorable outcome was defined as patient satisfaction and freedom from proton pump inhibitor use at 1 year. Associations were evaluated using multivariable logistic regression, receiver operating characteristic analysis, and decision curve analysis. RESULTS: Among 1,068 patients, 76.7% achieved a favorable outcome. Conventional surgical criteria were associated with favorable outcomes (adjusted odds ratio 1.93; p=0.006). Patients meeting both frameworks had the highest favorable outcome rate (79.7%). However, 26.1% met conventional surgical criteria but not Lyon 2.0 criteria, and 73.1% of these patients achieved a favorable outcome. Discrimination did not differ significantly between Lyon 2.0 and conventional criteria (area under the curve 0.571 vs 0.558; p=0.469). CONCLUSIONS: Lyon 2.0 and conventional surgical criteria identify overlapping but distinct ARS populations. Nearly three-quarters of patients meeting conventional criteria but not Lyon 2.0 achieved a favorable outcome. Failure to meet Lyon 2.0 criteria alone should not be used to exclude patients from operative consideration.