Clinical utility of Eckardt Score and high-resolution manometry in the follow-up of achalasia patients treated with Heller–Dor myotomy

Achalasia is a chronic esophageal motility disorder characterized by insufficient lower esophageal sphincter (LES) relaxation and ineffective peristalsis. Laparoscopic Heller myotomy with anterior Dor fundoplication (LHMD) is a widely accepted treatment for type I and II achalasia. Despite established guidelines for diagnosis and treatment, postoperative follow-up strategies remain poorly defined. This study aimed to evaluate the role of the Eckardt score (ES) and high-resolution manometry (HRM) during follow-up after LHMD. A prospective cohort of 59 achalasia patients (type I and II) treated with LHMD between January 2021 and January 2023 was analyzed. All patients underwent preoperative and postoperative assessments using ES and HRM at 1, 6, and 12 months. Demographic data, clinical characteristics, LES basal pressure, and integrated relaxation pressure (IRP) were collected and analyzed. Postoperative follow-up showed a significant and sustained reduction in Eckardt scores, LES basal pressure, and IRP compared to baseline (p < 0.05). These parameters remained stable across the three follow-up intervals, with no statistically significant differences between them. While most patients maintained clinical improvement, a subset experienced persistent or recurrent symptoms, primarily retrosternal pain and occasional dysphagia. No consistent correlation was found between manometric values and symptom severity during follow-up. HRM proved useful for confirming procedural success but had limited predictive value for clinical relapse. LHMD is a safe and effective surgical treatment for type I and II achalasia, resulting in lasting symptomatic and manometric improvements. The Eckardt score remains a practical tool for clinical follow-up. Routine HRM may not be necessary in asymptomatic patients with favorable postoperative evolution but should be considered in those with persistent or recurrent symptoms. Further studies are needed to clarify the prognostic role of HRM in long-term management.