ASGE Guidelines

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© 2026 American Society for Gastrointestinal Endoscopy. All rights reserved, including but not limited to those for text and data mining, artificial intelligence training, machine learning, and other similar technologies. For all open-source content, the relevant licensing terms apply.

ASGE evidence-based guidelines provide clinicians with recommendations for the evaluation, diagnosis, and management of patients undergoing endoscopic procedures of the digestive tract. Guidelines are not a substitute for physicians’ opinion on individual patients. Final decision on an intervention should always be based on local expertise and patient preferences.

All recommendations follow a rigorous process based on a systematic review of medical literature as outlined by the National Academy of Medicine (formerly Institute of Medicine) standards for guideline development.

Whenever possible, guidelines are based on the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology.

Panels consist of content experts, stakeholders from other specialties, patient representatives, and members of the ASGE Standards of Practice (SOP) Committee.

Each recommendation is based on consideration of the best medical literature, the balance between risks and benefits, cost-effectiveness, patients’ values, and equity. For more information, see the American Society for Gastrointestinal Endoscopy clinical practice guideline development policy and checklist.

Panel members provide ongoing conflict of interest (COI) disclosures, including intellectual conflicts of interest, throughout the development and publication of all guidelines in accordance with the ASGE Policy for Managing Declared Conflicts of Interests.

ASGE strives to provide clinically relevant and practical recommendations, which can help standardize patient care and improve outcomes.

If you have any questions or suggestions, please contact Customer Support at Info@asge.org.

The following information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.

Newly Published

ASGE guideline on the management of achalasia

Mar 3, 2020, 11:01 AM
Achalasia is a primary esophageal motor disorder of unknown etiology characterized by degeneration of the myenteric plexus, which results in impaired relaxation of the esophagogastric junction (EGJ), along with the loss of organized peristalsis in the esophageal body. The criterion standard for diagnosing achalasia is highresolution esophageal manometry showing incomplete relaxation of the EGJ coupled with the absence of organized peristalsis. Three achalasia subtypes have been defined based on high-resolution manometry findings in the esophageal body. Treatment of patients with achalasia has evolved in recent years with the introduction of peroral endoscopic myotomy. Other treatment options include botulinum toxin injection, pneumatic dilation, and Heller myotomy. This American Society for Gastrointestinal Endoscopy Standards of Practice Guideline provides evidence-based recommendations for the treatment of achalasia, based on an updated assessment of the individual and comparative effectiveness, adverse effects, and cost of the 4 aforementioned achalasia therapies. (Gastrointest Endosc 2020;91:213-27.)
Mouen A. Khashab, MD,1,* Marcelo F. Vela, MD,2,* Nirav Thosani, MD,3,* Deepak Agrawal, MD, MPH, MBA,4 James L. Buxbaum, MS, FASGE,5 Syed M. Abbas Fehmi, MD, MSc, FASGE,6 Douglas S. Fishman, MD, FAAP, FASGE,7 Suryakanth R. Gurudu, MD, FASGE,2 Laith H. Jamil, MD, FASGE,8 Terry L. Jue, MD, FASGE,9 Bijun Sai Kannadath, MBBS, MS,3 Joanna K. Law, MD,10 Jeffrey K. Lee, MD, MAS,11 Mariam Naveed, MD,12 Bashar J. Qumseya, MD, MPH,13 Mandeep S. Sawhney, MD, MS, FASGE,14 Julie Yang, MD, FASGE,15 Sachin Wani, MD, ASGE Standards of Practice Committee Chair16
Title : ASGE guideline on the management of achalasia
Doi org link : https://doi.org/10.1016/j.gie.2019.04.231
Volume : Gastrointest Endosc 2020; Volume 91, Issue 2; P213-227.E6
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Content created : Mar 3, 2020, 11:00 AM
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GRADE Guidelines

ASGE guideline on the management of achalasia

Mar 3, 2020, 11:01 AM
Achalasia is a primary esophageal motor disorder of unknown etiology characterized by degeneration of the myenteric plexus, which results in impaired relaxation of the esophagogastric junction (EGJ), along with the loss of organized peristalsis in the esophageal body. The criterion standard for diagnosing achalasia is highresolution esophageal manometry showing incomplete relaxation of the EGJ coupled with the absence of organized peristalsis. Three achalasia subtypes have been defined based on high-resolution manometry findings in the esophageal body. Treatment of patients with achalasia has evolved in recent years with the introduction of peroral endoscopic myotomy. Other treatment options include botulinum toxin injection, pneumatic dilation, and Heller myotomy. This American Society for Gastrointestinal Endoscopy Standards of Practice Guideline provides evidence-based recommendations for the treatment of achalasia, based on an updated assessment of the individual and comparative effectiveness, adverse effects, and cost of the 4 aforementioned achalasia therapies. (Gastrointest Endosc 2020;91:213-27.)
Mouen A. Khashab, MD,1,* Marcelo F. Vela, MD,2,* Nirav Thosani, MD,3,* Deepak Agrawal, MD, MPH, MBA,4 James L. Buxbaum, MS, FASGE,5 Syed M. Abbas Fehmi, MD, MSc, FASGE,6 Douglas S. Fishman, MD, FAAP, FASGE,7 Suryakanth R. Gurudu, MD, FASGE,2 Laith H. Jamil, MD, FASGE,8 Terry L. Jue, MD, FASGE,9 Bijun Sai Kannadath, MBBS, MS,3 Joanna K. Law, MD,10 Jeffrey K. Lee, MD, MAS,11 Mariam Naveed, MD,12 Bashar J. Qumseya, MD, MPH,13 Mandeep S. Sawhney, MD, MS, FASGE,14 Julie Yang, MD, FASGE,15 Sachin Wani, MD, ASGE Standards of Practice Committee Chair16
Title : ASGE guideline on the management of achalasia
Doi org link : https://doi.org/10.1016/j.gie.2019.04.231
Volume : Gastrointest Endosc 2020; Volume 91, Issue 2; P213-227.E6
URL :
Select a choice : Keep
Content created : Mar 3, 2020, 11:00 AM
File size :
Number :
ExternalPK :
Categories :
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Upper GI

ASGE guideline on the management of achalasia

Mar 3, 2020, 11:01 AM
Achalasia is a primary esophageal motor disorder of unknown etiology characterized by degeneration of the myenteric plexus, which results in impaired relaxation of the esophagogastric junction (EGJ), along with the loss of organized peristalsis in the esophageal body. The criterion standard for diagnosing achalasia is highresolution esophageal manometry showing incomplete relaxation of the EGJ coupled with the absence of organized peristalsis. Three achalasia subtypes have been defined based on high-resolution manometry findings in the esophageal body. Treatment of patients with achalasia has evolved in recent years with the introduction of peroral endoscopic myotomy. Other treatment options include botulinum toxin injection, pneumatic dilation, and Heller myotomy. This American Society for Gastrointestinal Endoscopy Standards of Practice Guideline provides evidence-based recommendations for the treatment of achalasia, based on an updated assessment of the individual and comparative effectiveness, adverse effects, and cost of the 4 aforementioned achalasia therapies. (Gastrointest Endosc 2020;91:213-27.)
Mouen A. Khashab, MD,1,* Marcelo F. Vela, MD,2,* Nirav Thosani, MD,3,* Deepak Agrawal, MD, MPH, MBA,4 James L. Buxbaum, MS, FASGE,5 Syed M. Abbas Fehmi, MD, MSc, FASGE,6 Douglas S. Fishman, MD, FAAP, FASGE,7 Suryakanth R. Gurudu, MD, FASGE,2 Laith H. Jamil, MD, FASGE,8 Terry L. Jue, MD, FASGE,9 Bijun Sai Kannadath, MBBS, MS,3 Joanna K. Law, MD,10 Jeffrey K. Lee, MD, MAS,11 Mariam Naveed, MD,12 Bashar J. Qumseya, MD, MPH,13 Mandeep S. Sawhney, MD, MS, FASGE,14 Julie Yang, MD, FASGE,15 Sachin Wani, MD, ASGE Standards of Practice Committee Chair16
Title : ASGE guideline on the management of achalasia
Doi org link : https://doi.org/10.1016/j.gie.2019.04.231
Volume : Gastrointest Endosc 2020; Volume 91, Issue 2; P213-227.E6
URL :
Select a choice : Keep
Content created : Mar 3, 2020, 11:00 AM
File size :
Number :
ExternalPK :
Categories :
Tags :
Lower GI
Biliary and Pancreatic Endoscopy
Adverse Events
Privileging and Credentialing
GI Endoscopy Unit Operations
Screening and Surveillance in Premalignant Conditions
Procedural Management in Endoscopy
Miscellaneous
Guidelines in Spanish

In Progress Guidelines

ASGE Guideline on management of code status in the periendoscopic period

Estimated 2025

Quality in Endoscopy

Quality documents define the indicators of high-quality endoscopy and how to measure it. ASGE quality indicators are based on a rigorous review process which results in valid metrics for evaluating GI endoscopic procedures.

Quality in Endoscopy

Public Comment

ASGE guidelines approaching publication are available on the website for 30 days for public comment. All reviewers are required to submit a conflict-of-interest disclosure and acknowledge a non-disclosure agreement for the guideline draft. All comments will be reviewed by the SOP Committee. Revisions to the draft are at the discretion of the lead authors and the SOP Committee.

ASGE Guideline on management of esophageal and gastric varices in patients with cirrhosis

Comment