BACKGROUND: Primary motor esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder identified by high-resolution manometry (HRM) in the absence of an underlying structural or mechanical cause of obstruction. The clinical significance, management, and prognosis of primary motor EGJOO remain uncertain. This clinical practice update provides expert guidance on the evaluation and management of EGJOO, with particular emphasis on determining when the condition is "actionable"-that is, likely to benefit from lower esophageal sphincter (LES)-directed therapies.

METHODS: With the endorsement of the European Society of Neurogastroenterology and Motility, an 11-member international Working Group developed recommendation statements on EGJOO, focusing on the diagnosis and management of actionable primary motor EGJOO. Statements were developed based on available literature evidence and presented at virtual meetings. Each statement was voted upon by the Working Group, and statements reaching ≥ 80% agreement were included as recommendations.

RESULTS: Twelve statements reached the agreement threshold. In summary, the Working Group agrees that actionable primary motor EGJOO should be defined by the coexistence of clinical symptoms, a characteristic HRM pattern, and non-manometric corroborative tests, including endoscopy, barium esophagogram, and functional lumen imaging probe panometry, in the absence of secondary causes. Patients with actionable primary motor EGJOO may receive medical, endoscopic, and/or surgical treatment, based on level of confidence in the diagnosis, while those without do not require LES-directed invasive intervention.

CONCLUSIONS: This clinical practice update represents an evidence and expert opinion-based consensus on the most appropriate diagnostic and therapeutic workup of actionable primary motor EGJOO.