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Updated: Mar 9, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Management of achalasia in the UK, do we need new guidelines?
Jihene El Kafsi1, Antonio Foliaki2, Thomas C B Dehn3
1Oxford University Hospitals NHS Foundation Trust, Oxford OesophagoGastric Center, Churchill Hospital, Oxford, OX3 9DU, UK.
Insights
UK surgeons primarily manage achalasia surgically, with limited multidisciplinary team (MDT) discussion and variable follow-up. Access to high-resolution manometry (HRM) for achalasia diagnosis remains restricted.
Area of Science:
- Gastroenterology
- Surgical Practice
- Clinical Management
Background:
- Current guidelines recommend multidisciplinary team (MDT) discussion for complex benign upper gastrointestinal pathology.
- High-volume centers and objective post-procedural investigations are advised for improved patient outcomes in achalasia management.
- This study surveys current UK practices in achalasia management.
Approach:
- A SurveyMonkey questionnaire was distributed to 443 Upper Gastrointestinal (UGI) specialist surgeons across the UK.
- 100 responses were analyzed to understand current diagnostic and treatment strategies for achalasia.
Key Points:
- Most achalasia patients are referred directly to surgeons (80%), with only 15% of units utilizing MDT meetings.
- Diagnosis commonly involves oesophagogastroduodenoscopy (OGD) and contrast swallow; access to high-resolution manometry (HRM) is limited to 61% of units.
- Surgery is the primary initial treatment for both younger (89%) and elderly (55%) patients, with partial fundoplication frequently performed (91%).
Conclusions:
- Achalasia diagnosis and management in the UK show some standardization, but limited HRM access persists.
- Multidisciplinary team (MDT) discussion for benign conditions is infrequent, and patient follow-up protocols vary significantly.
- The development of UK-specific guidelines could promote greater uniformity in achalasia care.
Aim:
It is recommended that management of complex benign upper gastrointestinal pathology is discussed at multi disciplinary team (MDT) meetings. American College of Gastroenterology (ACG) guidelines further recommend that treatment delivery is provided by high volume centres, with objective post-procedural investigations, in order to improve patient outcomes. We aimed to survey the current UK practice in the management of achalasia.
Methods:
443 Upper gastrointestinal (UGI) specialist surgeons throughout the UK were sent a surveymonkey.com questionnaire about the management of achalasia.
Results:
100 responses were received. The majority of patients with achalasia are referred directly to surgeons (80%) and only 15% of units have a MDT meeting for discussing such patients. Diagnosis was mainly with oesophagogastroduodenoscopy (OGD) and contrast swallow, and only 61% of units have access to high resolution manometry (HRM). 89% of younger patients were offered surgery initially, whilst in the elderly surgery was offered as first line treatment in 55%. Partial fundoplication was carried out by 91% of responders as part of the operation, and 58% responders carry out an intraoperative OGD. The average number of operations carried out per annum is 4 per responder. Most responders (66%) did not perform routine post-intervention investigations and follow-up varied from none to lifelong.
Conclusion:
Diagnosis and management of achalasia within the UK is relatively standardised, although there remains limited access to HRM. Discussion at benign MDTs however is poor and follow-up differs widely. UK guidelines may help to make these more uniform.
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