TABLE 1.
Quality indicators deemed to be valid by consensus opinion from 17 experts using two-round Delphi technique.
| Quality Indicator | Agreement (%) | |||
|---|---|---|---|---|
| Importance | Scientific Acceptability | Usability | Feasibility | |
| IF a patient has dysphagia in the context of suspected achalasia, THEN an endoscopy with esophageal biopsies should be performed to rule out mechanical obstruction or eosinophilic esophagitis. | 94.1 | 88.2 | 94.1 | 94.1 |
| IF symptoms of GERD occur after achalasia treatment, THEN the patient should be treated with an anti-reflux regimen. | 93.3 | 93.3 | 100 | 100 |
| IF a patient with esophageal dysphagia has an endoscopy with esophageal biopsies and the results are unrevealing THEN high- resolution stationary esophageal manometry should be pursued. | 93.8 | 93.8 | 93.8 | 93.8 |
| If manometry is performed, THEN high-resolution technology should be used. | 93.8 | 100 | 100 | 87.5 |
| IF high-resolution manometry is performed, THEN the Chicago classification v3.0 should be used to help define clinically relevant phenotypes using a standardized language. | 93.8 | 93.8 | 93.8 | 100 |
| IF a patient is diagnosed with achalasia, THEN the patient should be educated on all treatment options with a discussion on risk and benefits. | 100 | 100 | 93.8 | 87.5 |
| IF myotomy (surgical or endoscopic) is performed in achalasia, THEN patients should be made aware of the potential risk of developing gastroesophageal reflux disease (GERD) following myotomy. | 100 | 100.0 | 100 | 93.8 |
| IF a patient diagnosed with achalasia undergoes laparoscopic surgical myotomy, THEN concomitant partial fundoplication can be performed. | 93.8 | 93.8 | 100 | 100 |
| IF a patient with a diagnosis of achalasia is healthy THEN Botox should not be offered as a long-term treatment option. | 100 | 93.8 | 93.8 | 87.5 |
| IF a patient is diagnosed with achalasia and is high risk for surgery or has a short life expectancy, THEN Botox can be considered. | 93.8 | 87.5 | 87.5 | 93.8 |
| IF symptoms due to achalasia return after achalasia treatment, THEN an objective re-evaluation should be completed. | 100.0 | 100 | 100 | 100 |
| IF a patient diagnosed with achalasia responds to a form of treatment and has recurrent symptoms, THEN the patient will likely need additional endoscopic or surgical therapies in the future. | 93.8 | 93.8 | 87.5 | 87.5 |