Endoscopy 2020; 52(06): 498-515
DOI: 10.1055/a-1160-5549
Guideline

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

Bas L. A. M. Weusten
 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
,
Maximilien Barret
 3  Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
,
Albert J. Bredenoord
 4  Department of Gastroenterology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
,
Pietro Familiari
 5  Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
,
Jan-Michel Gonzalez
 6  Department of Gastroenterology, Hôpital Nord, Marseille, France
,
Jeanin E. van Hooft
 4  Department of Gastroenterology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
,
Sauid Ishaq
 7  Department of Gastroenterology, Dudley Group NHS Foundation Trust and Birmingham City University, Birmingham, UK
,
Vicente Lorenzo-Zúñiga
 8  Endoscopy Unit, University Hospital La Fe, Valencia, Spain
,
Hubert Louis
 9  Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
,
Suzanne van Meer
 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
,
Helmut Neumann
10  Department of Medicine I, University Medical Center Mainz, Mainz, Germany
,
Daniel Pohl
11  Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland
,
Frederic Prat
 3  Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
,
Daniel von Renteln
12  Division of Gastroenterology, Montréal University Hospital (CHUM), Montréal, Canada
,
Edoardo Savarino
13  Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
,
Rami Sweis
14  Department of Gastroenterology, University College London Hospital, London, UK
,
Jan Tack
15  Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
,
Radu Tutuian
16  Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
,
Jan Martinek
17  Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
› Author Affiliations

Main Recommendations

ESGE 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 %.

Appendix 1s – 3s



Publication History

Publication Date:
06 May 2020 (online)

© Georg Thieme Verlag KG
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