Endoscopy 2020; 52(07): 600-614
DOI: 10.1055/a-1171-3174
Guideline

Endoscopic management of gastrointestinal motility disorders – part 2: 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-Hopitaux de Paris and University of Paris, France
,
Albert J. Bredenoord
 4   Department of Gastroenterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
,
Pietro Familiari
 5   Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
,
Jean-Michel Gonzalez
 6   Department of Gastroenterology, Hôpital Nord, Marseille, France
,
Jeanin E. van Hooft
 4   Department of Gastroenterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
,
Vicente Lorenzo-Zúñiga
 7   Endoscopy Unit, University Hospital La Fe, Valencia, Spain
,
Hubert Louis
 8   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
,
Jan Martinek
 9   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
,
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-Hopitaux de Paris and University of 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 Padova, Padova, 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
,
Sauid Ishaq
17   Department of Gastroenterology, Dudley Group NHS Foundation Trust and Birmingham City University, Birmingham, UK
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Correction: Endoscopic management of gastrointestinal motility disorders – part 2: European Society of Gastrointestinal Endoscopy (ESGE) GuidelineEndoscopy 2020; 52(07): C7-C7
DOI: 10.1055/a-1201-7524

Main Recommendations

ESGE suggests flexible endoscopic treatment over open surgical treatment as first-line therapy for patients with a symptomatic Zenker’s diverticulum of any size.

Weak recommendation, low quality of evidence, level of agreement 100 %.

ESGE recommends that emerging treatments for Zenker’s diverticulum, such as Zenker’s peroral endoscopic myotomy (Z-POEM) and tunneling, be considered as experimental; these treatments should be offered in a research setting only.

Strong recommendation, low quality of evidence, level of agreement 100 %.

ESGE recommends against the widespread clinical use of transoral incisionless fundoplication (TIF) as an alternative to proton pump inhibitor (PPI) therapy or antireflux surgery in the treatment of gastroesophageal reflux disease (GERD), because of the lack of data on the long-term outcomes, the inferiority of TIF to fundoplication, and its modest efficacy in only highly selected patients. TIF may have a role for patients with mild GERD who are not willing to take PPIs or undergo antireflux surgery.

Strong recommendation, moderate quality of evidence, level of agreement 92.8 %.

ESGE recommends against the use of the Medigus ultrasonic surgical endostapler (MUSE) in clinical practice because of insufficient data showing its effectiveness and safety in patients with GERD. MUSE should be used in clinical trials only.

Strong recommendation, low quality evidence, level of agreement 100 %.

ESGE recommends against the use of antireflux mucosectomy (ARMS) in routine clinical practice in the treatment of GERD because of the lack of data and its potential complications.

Strong recommendation, low quality evidence, level of agreement 100 %.

ESGE recommends endoscopic cecostomy only after conservative management with medical therapies or retrograde lavage has failed.

Strong recommendation, low quality evidence, level of agreement 93.3 %.

ESGE recommends fixing the cecum to the abdominal wall at three points (using T-anchors, a double-needle suturing device, or laparoscopic fixation) to prevent leaks and infectious adverse events, whatever percutaneous endoscopic cecostomy method is used.

Strong recommendation, very low quality evidence, level of agreement 86.7 %.

ESGE recommends considering endoscopic decompression of the colon in patients with Ogilvie’s syndrome that is not improving with conservative treatment.

Strong recommendation, low quality evidence, level of agreement 93.8 %.

ESGE recommends prompt endoscopic decompression if the cecal diameter is > 12 cm and if the Ogilvie’s syndrome exists for a duration of longer than 4 – 6 days.

Strong recommendation, low quality evidence, level of agreement 87.5 %.

Appendix 1s – 3s



Publication History

Article published online:
27 May 2020

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