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

Bas L. A. M. Weusten; Maximilien Barret; Albert J. Bredenoord; Pietro Familiari; Jan-Michel Gonzalez; Jeanin E. van Hooft; Sauid Ishaq; Vicente Lorenzo-Zúñiga; Hubert Louis; Suzanne van Meer; Helmut Neumann; Daniel Pohl; Frederic Prat; Daniel von Renteln; Edoardo Savarino; Rami Sweis; Jan Tack; Radu Tutuian; Jan Martinek

doi:10.1055/a-1160-5549

Endoscopy, Table of Contents

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

Authors

Bas L. A. M. Weusten

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

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

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

⁴Department of Gastroenterology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
Pietro Familiari

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

⁶Department of Gastroenterology, Hôpital Nord, Marseille, France
Jeanin E. van Hooft

⁴Department of Gastroenterology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
Sauid Ishaq

⁷Department of Gastroenterology, Dudley Group NHS Foundation Trust and Birmingham City University, Birmingham, UK
Vicente Lorenzo-Zúñiga

⁸Endoscopy Unit, University Hospital La Fe, Valencia, Spain
Hubert Louis

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

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

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

¹⁰Department of Medicine I, University Medical Center Mainz, Mainz, Germany
Daniel Pohl

¹¹Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland
Frederic Prat

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

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

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

¹⁴Department of Gastroenterology, University College London Hospital, London, UK
Jan Tack

¹⁵Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
Radu Tutuian

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

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

Abstract

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 %.

Full Text

References

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