In the last years, with the improvement of diagnostics and understanding of the pathogenesis of Achalasia, scientists have been considering a personalised approach to the treatment of esophageal dysmotility. 

AIM: To identify predictors of Achalasia and evaluate the results of endoscopic treatment.

In the Department of Surgery of Digestive organs of the Institute in may 2024 - september 2025, 29 patients diagnosed with Achalasia were examined and treated. There were 12 men and 17 women. The average age was 28-68 years (39.6±5.3). All patients underwent Eckardt score (dysphagia (0-5), regurgitation (0-5), chest pain (0-5)), X-ray (time barium swallows), endoscopic, EUS and HRM examination, and endoscopic treatment. 

According to HRM, Achalasia type I (n=10 /34.5%), type II (n=14 /48.3%), type III (n=2 /6.9%), EGJOO (n=3 /10.3%) were established. According to EUS with compression elastography, thickening of the lower third of the esophagus ≥ 3 mm and LES ≥ 5 mm were diagnosed in all cases. According to EUS-elastography of the LES, a blue pattern (fibrosis) was determined in 5 (17.2%) cases, and a green-yellow pattern (hypertrophy) was determined in 24 (82.8%) cases. Endoscopically, all patients showed esophageal dilation, congestive contents, and resistance to the endoscope when passing through the LES. All patients underwent pneumatic dilation (PD) using 3.5 cm Rigiflex ІІ balloons. The ineffectiveness of the PD course within 12 months was determined in 31.0%: Achalasia type I (n=2), type II (n=3), type III (n=1), EGJOO (n=3). In these cases, per oral endoscopic myotomy (POEM) was performed. Histologically, fibrosis was confirmed in cases of type I (n=2) and type II (n=3) Achalasia, and muscle hypertrophy was confirmed in cases of type III (n=1) and EGJOO (n=3). During the 12-month follow-up period, all patients showed clinical improvement according to the Eckardt score (p<0.01); according to the time baruim swallows assessment after 1 min, 2 min, and 5 min, a decrease in the diameter of the esophagus (p<0.01), acceleration of passage (p<0.01), and the appearance of a gastric gas bubble (p<0.01) were noted.

EUS allows differentiation between LES and esophageal muscle hypertrophy and their fibrotic transformation in Achalasia, which requires myotomy. HRM allows assessment of LES relaxation and esophageal motility, which influences the staging of PD or primary POEM. Reduction in esophageal diameter and LES relaxation are screening criteria in assessing the effectiveness of Achalasia treatment.