EAES Clinical Practice Guideline 2026 Protocol: Multi-Society Recommendations for the Treatment of Achalasia.

INTRODUCTION: Achalasia causes significant distress and quality-of-life impairment to patients. Several options exist for the treatment of achalasia including endoscopic [intra-sphincteric injection of botulinum toxin, pneumatic dilation, peroral endoscopic myotomy (POEM)], and surgical techniques such as Heller Myotomy. METHODS: This guideline will adhere to robust methodological standards according to GIN, GRADE, and AGREE-S. We will develop a clinical practice guideline addressing the treatment of patients with achalasia. A systematic review group will perform an evidence synthesis and network meta-analysis before appraising the certainty of evidence. An international, multidisciplinary panel will review the evidence and develop recommendations using the evidence-to-decision framework. The panel will be comprised of gastroenterologists, gastrointestinal surgeons, and patient partners. We will collect and address conflicts of interest for all guideline development group members. We will present this clinical practice guideline at international congresses and publish in the Journal of Surgical Endoscopy & Other Interventional Techniques. QUESTIONS: We will conduct a clinical practice guideline to provide evidence-informed treatment recommendations for patients with achalasia. We will examine the following questions:In patients with type I achalasia, what is the relative impact of Botox injection versus pneumatic dilation versus POEM versus Heller myotomy alone versus Heller myotomy with fundoplication on patient-important outcomes?In patients with type II achalasia, what is the relative impact of Botox injection versus pneumatic dilation versus POEM versus Heller myotomy alone versus Heller myotomy with fundoplication on patient-important outcomes?In patients with type III achalasia, what is the relative impact of Botox injection versus pneumatic dilation versus POEM versus Heller myotomy alone versus Heller myotomy with fundoplication on patient-important outcomes?