• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / High Resolution Manometry Sub-Classification of Achalasia: Does it really matter?

High Resolution Manometry Sub-Classification of Achalasia: Does it really matter?

Christina L Greene, MD, Erica J Chang, BA, Stephanie G Worrell, MD, Steven R DeMeester, MD, Daniel S Oh, MD, Jeffrey A Hagen, MD. Keck School of Medicine of the University of Southern California.

BACKGROUND: Three variants of achalasia have been described using high resolution esophageal manometry (HRM). While manometrically distinct their clinical significance has yet to be established. Our objective was to compare the response to myotomy in patients with these achalasia subtypes.                                           

METHODS: A retrospective chart review was performed to identify patients with achalasia who had HRM and who underwent laparoscopic Heller myotomy or Per Oral Endoscopic Myotomy (POEM). Symptoms and esophageal clearance by timed barium study were compared before and after treatment. Median values are reported except when indicated.                                                                                                       

RESULTS:We identified 43 patients, 19 males and 24 female, with a median age of 50 years. The primary symptom in all patients was dysphagia, with a median duration of 4 years (range 4 months to 50 years). Based on HRM 27 patients (63%) were classified as Type I, 9 (21%) as Type II and 7 (16%) as Type III. Patient characteristics and outcome are compared in the table. Relief of dysphagia was similar for the three achalasia subtypes, and the Eckardt score was below 3 in all but one patient. Dysphagia was relieved in 85% of Type I, 100% of Type II and 86% of Type III achalasia patients. Dysphagia persisted in five patients, all of whom had a laparoscopic Heller myotomy. There was no significant difference in dysphagia relief between POEM and laparoscopic myotomy. On pre-treatment timed barium study, no patient had complete emptying at 1 and 5 minutes. After myotomy complete emptying occurred within 1 minute in 52% (16/31) and within 5 minutes in 58% (18/31) and was similar across groups.         

  Type I (n=27) Type II (n=9) Type III (n=7) P value
Sex (Male: Female) 12:15 3:6 4:3 0.04
Age (range) 50 (24-76) 33 (20-65) 62 (20-67) 0.13
Duration of Symptoms 4 yrs 5 yrs 4 yrs 0.48
Pre-Operative LES Characteristics        

  – Resting Pressure

25 mmHg 26 mmHg 28 mmHg 0.91
  – Residual Pressure 21 mmHg 31 mmHg 21 mmHg 0.51
  – % Relaxation 21% 25% 32% 0.67

Operation

       

  – Heller Myotomy with Fundoplication

23 (85%) 7 (78%) 5 (71%) 0.21
  – POEM 4 (15%) 2 (22%) 2 (29%)  
Relief of Dysphagia

23/27  (85%)

0/9   (100%) 6/7       (86%) 0.3
Post-Op Eckardt Score 1 0 0 0.18

Post-Op Timed Barium

 (n=20) (n=8) (n=3)  
  – Complete Emptying @ 1min 8 (40%) 6 (75%) 2 (67%) 0.89
  – Complete Emptying @ 5min 10 (50%) 6 (75%) 2 (67%) 0.29

CONCLUSION: Myotomy for achalasia results in excellent symptomatic outcome and improvement in esophageal clearance. There was no difference among the described HRM achalasia variants. This calls into question the clinical relevance of achalasia sub-classification and affirms the benefit of myotomy for this disease.
 

View Poster

267

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals