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

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 %.

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Déclaration de conflit d'intérêts

A.J. Bredenoord has received speaker’s fees from MMS, Diversatek, and Medtronics (ongoing). P. Familiari received speaker’s fees from Olympus (October 2019). H. Neumann has provided consultancy services to Fujifilm, Pentax, Motus GI, Boston Scientific, and Cook Medical (2012 to present). D. Pohl has provided consultancy services to Medtronic (2018 to present). R. Tutuian has provided consultancy services and educational programs to Laborie/MMS (2010 to present). J.E. van Hooft has received lecture fees from Medtronics (2014 – 2015) and consultancy fees from Boston Scientific (2014 – 2017); her department has received research grants from Cook Medical (2014 – 2018) and Abbott (2014 – 2017). D. von Renteln has received research funding from Pendopharm (2016 – 2019), Ventage and Pentax (2018 – 2019), ERBE (2019 to present), and Boston Scientific (2020), and speaker’s fees from Boston Scientific (2018 – 2020) and ERBE (2020).M. Barret, J.-M. Gonzalez, S. Ishaq, V. Lorenzo-Zúñiga, H. Louis, J. Martinek, F. Prat, E. Savarino, R. Sweis, J. Tack, S. van Meer, and B.L.A.M. Weusten declare that they have no conflict of interest.