Real-world management of achalasia and esophagogastric junction outlet obstruction in Italy: results from a national survey

There is significant variability in clinical guidelines for achalasia, and precise indications for Esophagogastric Junction Outflow Obstruction (EGJOO) are lacking. The recommendations provided in the published literature could be difficult to translate into the clinical practice due to the discrepancy in the available resources. This survey aims to provide insight into the different diagnostic and therapeutic approaches adopted nationwide. An electronic 31-item questionnaire was sent among the members of the Italian Society for Endoscopic Surgery of Endoscopic Surgery and New Technologies (SICE). A single response from each participating center was required. A total of 46 answers were obtained. The first approach to achalasia was Heller myotomy plus Dor fundoplication (H-D) in most cases, but there was an increased use of Per-Oral Endoscopic Myotomy (POEM) for subtype III achalasia. Botulin toxin injection (BTX) and PD were reserved for frail, older patients. Surgery was the primary approach for end-stage achalasia, mainly H-D (50.0%), esophagectomy (22.7%), and PD (20.5%). A conclusive diagnosis of EGJOO was managed through PD (32.6%), clinical observation (21.7%), H-D (17.4%), Proton Pump Inhibitors (PPIs) (13.0%), BTX (13.0%) and POEM (2.2%) while an inconclusive EGJOO diagnosis through clinical observation (39.1%), PD (23.9%), H-D (21.7%), PPIs (8.7%) and POEM (6.5%). The suggested timing was 3 months (72.7%) for clinical and 6 months (63.6%) for instrumental follow-up. In case of persistence of symptoms, the preferred treatments were H-D (50.0%) and PD (28.3%). This study provides a real-world snapshot of the management of achalasia and EGJOO in the Italian landscape, showing a wide variability in the clinical practice among the involved centers. A multidisciplinary approach is advisable, and clinical guidelines are warranted to provide shared decisions for the management of these disorders.

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Publication Details

Journal
Updates in Surgery
Published
2025-09-24
DOI
https://doi.org/10.1007/s13304-025-02406-8
Citations
2
Primary Topic
Gastroesophageal reflux and treatments
Type
article
Field-Weighted Citation Impact
3.62

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article

Real-world management of achalasia and esophagogastric junction outlet obstruction in Italy: results from a national survey

Serena Di Cosimo, Gabriele Anania, Fabrizio Rebecchi, Andrea Di Giorgio et al.
2 citations
Updates in Surgery
Gastroesophageal reflux and treatments
3.62
article

Real-world management of achalasia and esophagogastric junction outlet obstruction in Italy: results from a national survey

Serena Di Cosimo, Gabriele Anania, Fabrizio Rebecchi, Andrea Di Giorgio, Angelo Iossa, Giovanni Alessio, Luigi Eduardo Conte, Salvatore Buscemi, Bruno Rustum Andréa, Giovanni Guglielmo Laracca, Andrea Peri, Salomone Di Saverio, Elettra Ugliono, Manuela De Michele, Daniel E. Michele, Stefano Olmi, Domenico Di Giorgio, Nicola Tamburini, Jacopo Andreuccetti, Marco Clementi, Danilo Consalvo, Gennaro Martines, Giuseppe Milone, C Villafani Diego, Graziano Pernazza, Luca De Nicola, Bonventre Sebastiano, M Silva Junior Mario, Bonavina Luigi, Galleano Raffaele, Bona Davide, Antonio Alberto, Giorgio Romano, A. De Michele, Carlo Maria De Filippo, G. Monica, D. Daniele, Spinelli Antonio, F C Fransen Laura, Anestiadou Elissavet, Barletta Gabriele, Capuano Marianna, Fernicola Agostino, Fontana Tommaso, Froiio Caterina, Iannone Immacolata, Jeong Juhye, Merlini Ilenia, Saullo Paolina, Tebala Giovanni
article en
2 citations

Abstract

There is significant variability in clinical guidelines for achalasia, and precise indications for Esophagogastric Junction Outflow Obstruction (EGJOO) are lacking. The recommendations provided in the published literature could be difficult to translate into the clinical practice due to the discrepancy in the available resources. This survey aims to provide insight into the different diagnostic and therapeutic approaches adopted nationwide. An electronic 31-item questionnaire was sent among the members of the Italian Society for Endoscopic Surgery of Endoscopic Surgery and New Technologies (SICE). A single response from each participating center was required. A total of 46 answers were obtained. The first approach to achalasia was Heller myotomy plus Dor fundoplication (H-D) in most cases, but there was an increased use of Per-Oral Endoscopic Myotomy (POEM) for subtype III achalasia. Botulin toxin injection (BTX) and PD were reserved for frail, older patients. Surgery was the primary approach for end-stage achalasia, mainly H-D (50.0%), esophagectomy (22.7%), and PD (20.5%). A conclusive diagnosis of EGJOO was managed through PD (32.6%), clinical observation (21.7%), H-D (17.4%), Proton Pump Inhibitors (PPIs) (13.0%), BTX (13.0%) and POEM (2.2%) while an inconclusive EGJOO diagnosis through clinical observation (39.1%), PD (23.9%), H-D (21.7%), PPIs (8.7%) and POEM (6.5%). The suggested timing was 3 months (72.7%) for clinical and 6 months (63.6%) for instrumental follow-up. In case of persistence of symptoms, the preferred treatments were H-D (50.0%) and PD (28.3%). This study provides a real-world snapshot of the management of achalasia and EGJOO in the Italian landscape, showing a wide variability in the clinical practice among the involved centers. A multidisciplinary approach is advisable, and clinical guidelines are warranted to provide shared decisions for the management of these disorders.

Updates in SurgeryVol. 77(8)
Azienda Ospedaliera San Giovanni Addolorata (IT), Ospedale Antonio Cardarelli (IT), Azienda Unità Sanitaria Locale di Ferrara (IT), Arcispedale Sant'Anna (IT), Department of Medical Sciences (BY), Azienda di Rilievo Nazionale ed Alta Specializzazione (IT)
Università degli Studi di Torino
Openalex Percentile: Top 7%
Gastroesophageal reflux and treatments
3.62
DOIOpen Access PDFOpenAlex
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