Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands.
Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.
Endoscopy. 2020 Jun;52(6):498-515. doi: 10.1055/a-1160-5549. Epub 2020 May 6.
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 %.
ESGE 建议在贲门失弛缓症中使用分级气动扩张方案，从 30mm 扩张开始，然后在 2-4 周的计划间隔内进行 35mm 扩张，如果缓解不足，随后进行 40mm 扩张，无论是在单次球囊扩张过程中还是从一开始就使用更大的球囊。强烈推荐，高质量证据，一致性水平 100%。
ESGE 建议在治疗除贲门失弛缓症以外的其他痉挛性运动障碍时要谨慎使用经口内镜肌切开术（POEM）。强烈推荐，极低质量证据，一致性水平 87.5%。
ESGE 不建议常规使用肉毒毒素注射治疗非贲门失弛缓症性高收缩性食管运动障碍（痉挛性食管）。然而，如果在个别患者中选择内镜下注射肉毒毒素，ESGE 建议在下食管括约肌的四个象限和食管下段的下三分之一进行注射。强烈推荐，低质量证据，一致性水平 78.6%。
ESGE 建议仅在有胃轻瘫症状且经验证的测试证实存在胃排空延迟的客观证据的患者中考虑内镜幽门靶向治疗，并且仅在药物治疗失败时才考虑。强烈推荐，极低质量证据，一致性水平 100%。
ESGE 建议不要在未经选择的胃轻瘫患者中使用肉毒毒素注射治疗。强烈推荐，高质量证据，一致性水平 92.9%。
ESGE 建议仅在仔细选择的患者中考虑胃经口内镜肌切开术（G-POEM），因为它是一种新兴的治疗方法，其有效性、安全性和耐久性数据有限。G-POEM 只能在专家中心进行，最好在临床试验的背景下进行。强烈推荐，低质量证据，一致性水平 100%。
