TABLE 2.
Quality indicators determined to have low validity by consensus opinion from 17 experts using two-round Delphi technique.
| Quality Indicator | Agreement (%) | |||
|---|---|---|---|---|
| Importance | Scientific Acceptability | Usability | Feasibility | |
| IF manometry findings are equivocal, THEN esophagogram should be used to assess EGJ morphology and assess esophageal emptying. | 41.2 | 41.2 | 41.2 | 41.2 |
| IF the diagnosis of achalasia is made, THEN the Eckardt score should be documented to help measure symptom severity and response to treatment. | 11.8 | 11.8 | 35.3 | 52.9 |
| IF a patient is diagnosed with achalasia, THEN treatment with hydraulic dilation (ie, EsoFLIP™) is reasonable. | 33.3 | 26.7 | 21.4 | 7.1 |
| IF a patient is treated for a diagnosis of achalasia, THEN symptom improvement should be monitored by Eckardt score. | 13.3 | 20.0 | 26.7 | 40.0 |
| IF symptoms due to achalasia return after achalasia treatment with confirmed achalasia on objective testing, THEN patients are still a candidate for re-treatment with the same or different modality. | 57.1 | 42.9 | 42.9 | 64.3 |
| IF manometry confirms achalasia, THEN a timed barium esophagogram should be pursued to provide objective measure in the evaluation of treatment response. | 50.0 | 31.3 | 43.8 | 50.0 |
| IF a patient is diagnosed with achalasia, THEN pseudoachalasia should be first excluded. | 50.0 | 50.0 | 50.0 | 43.8 |
| IF a patient is presenting with dysphagia and the diagnosis is unclear for achalasia, THEN a trial of Botox or EndoFLIP technology, if available, can be used for diagnostic purposes. | 43.8 | 25.0 | 31.3 | 31.3 |
| IF a patient undergoes treatment for achalasia, THEN they should be counseled on the chronic nature of the disease and potential risk of progression to end-stage esophagus despite control of symptoms. | 75.0 | 68.8 | 68.8 | 68.8 |
| IF a patient is diagnosed with end-stage achalasia, THEN esophagectomy or percutaneous endoscopic gastrostomy (PEG) should be discussed as a treatment option. | 56.3 | 43.8 | 68.8 | 56.3 |
| IF a patient undergoes achalasia treatment and develops classic GERD symptoms, THEN the patient should be empirically treated with a proton pump inhibitor (PPI). | 62.5 | 56.3 | 68.8 | 81.3 |
| IF a patient has treated or untreated achalasia, THEN documentation should include counseling on the potential increased relative risk of squamous cell carcinoma. | 43.8 | 31.3 | 31.3 | 37.5 |
| IF a high-risk patient has treated or untreated achalasia, THEN they should undergo squamous cell carcinoma surveillance. | 25.0 | 12.5 | 12.5 | 25.0 |
| IF surveillance for squamous cell carcinoma in achalasia is started in high-risk patients with treated or untreated achalasia, THEN surveillance should extend in duration as long as the benefits of EGD outweigh the risk. | 43.8 | 31.3 | 31.3 | 31.3 |