Achalasia Guidelines: Evidence, Decisions, and Treatment Pathways

In this episode of Inside Surgery, host Dr. Alice Tsai hands over to surgical resident Dr. Bright Huo (Surgical Resident, McMaster University, Canada) to explore the development of the upcoming 2026 multi-society clinical guidelines on the management of Achalasia.

Joined by Dr. Stavros Antoniou (Chair Guidelines Committee, Greece), Prof. Milos Belovich (Bariatric Surgeon, Chair of Education & Training Committee. Serbia), and Assoc. Prof. Sonia Fernandez-Ananin (Consultant Upper GI & Bariatric Surgeon, Spain), the panel discusses how the guidelines were developed using rigorous evidence synthesis and the GRADE methodology, combining statistical analysis, expert consensus, and patient input.

The episode covers key treatment recommendations, including the role of Heller Myotomy with Fundoplication as the preferred option for patients with moderate to severe symptoms who are fit for surgery, and POEM (Peroral Endoscopic Myotomy) as an important alternative for those who are not surgical candidates or prefer a less invasive approach. Other options such as Pneumatic Dilation and Botox Injection are discussed in the context of symptom severity and long-term effectiveness.

A key focus throughout is shared decision-making, with many recommendations being conditional and requiring clinicians to balance evidence, patient preferences, and local access to treatments.

The conversation also reflects on the complexity of modern guideline development, the challenges of interpreting evolving evidence, and how participation in the process has influenced clinical practice.

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