Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Author:

Weusten Bas L. A. M.12,Barret Maximilien3,Bredenoord Albert J.4,Familiari Pietro5,Gonzalez Jan-Michel6,van Hooft Jeanin E.4,Ishaq Sauid7,Lorenzo-Zúñiga Vicente8,Louis Hubert9,van Meer Suzanne12,Neumann Helmut10,Pohl Daniel11,Prat Frederic3,von Renteln Daniel12,Savarino Edoardo13,Sweis Rami14,Tack Jan15,Tutuian Radu16,Martinek Jan17

Affiliation:

1. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands

2. Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands

3. Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France

4. Department of Gastroenterology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands

5. Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy

6. Department of Gastroenterology, Hôpital Nord, Marseille, France

7. Department of Gastroenterology, Dudley Group NHS Foundation Trust and Birmingham City University, Birmingham, UK

8. Endoscopy Unit, University Hospital La Fe, Valencia, Spain

9. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

10. Department of Medicine I, University Medical Center Mainz, Mainz, Germany

11. Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland

12. Division of Gastroenterology, Montréal University Hospital (CHUM), Montréal, Canada

13. Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy

14. Department of Gastroenterology, University College London Hospital, London, UK

15. Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium

16. Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland

17. Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Abstract

Main RecommendationsESGE recommends the use of a graded pneumatic dilation protocol in achalasia, starting with a 30-mm dilation and followed by a 35-mm dilation at a planned interval of 2 – 4 weeks, with a subsequent 40-mm dilation when there is insufficient relief, over both a single balloon dilation procedure or the use of a larger balloon from the outset.Strong recommendation, high quality of evidence, level of agreement 100 %.ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM).Strong recommendation, very low quality of evidence, level of agreement 87.5 %.ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus.Strong recommendation, low quality of evidence, level of agreement 78.6 %.ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed.Strong recommendation, very low quality of evidence, level of agreement 100 %.ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis. Strong recommendation, high quality of evidence, level of agreement 92.9 %.ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial.Strong recommendation, low quality of evidence, level of agreement 100 %.

Publisher

Georg Thieme Verlag KG

Subject

Gastroenterology

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