Association between preoperative pan-esophageal pressurization and peristalsis recovery after per-oral endoscopic myotomy in achalasia.

BACKGROUND

Per-oral endoscopic myotomy (POEM) has become the mainstream treatment for achalasia. Previous studies have found that some patients with achalasia might experience partial recovery of esophageal peristalsis after POEM. However, the clinical significance of this recovery and the associated factors remain to be further elucidated.

METHODS

This was a multicenter retrospective cohort study conducted by four academic hospitals in China. Patients diagnosed with achalasia who underwent POEM between 2020 and 2025 were included. Demographics, Eckardt score, gastroesophageal reflux disease questionnaire (GERDQ) score, presence of esophagitis, high-resolution manometry parameters, and myotomy length were collected. Normal, weak, and fragmented contractions were defined as partial recovery of esophageal peristalsis.

RESULTS

Partial recovery of esophageal peristalsis was observed in 32.8% (95 of 290) of patients with achalasia. A significantly higher preoperative proportion of pan-esophageal pressurization was found in the recovery group compared with the non-recovery group [median (interquartile range), 80.0% (30.0%, 100.0%) vs 30.0% (0.0%, 90.0%), P < 0.001] and this proportion positively correlated with the degree of peristalsis recovery (r = 0.247, P < 0.001). Patients with peristalsis recovery had significantly lower GERDQ scores and reduced incidence of dysphagia symptoms. Multivariate analysis further confirmed that the preoperative proportion of pan-esophageal pressurization was an independent predictor of peristalsis recovery (odds ratio = 1.02, P = 0.007).

CONCLUSIONS

A higher preoperative proportion of pan-esophageal pressurization was independently associated with postoperative recovery of esophageal peristalsis in patients with achalasia. Peristalsis recovery was related to superior symptom relief. Preoperative assessment of pan-esophageal pressurization might help guide individualized postoperative follow-up and patient counseling.