Comparative outcomes of peroral endoscopic myotomy treatment in type I and type <scp>II</scp> achalasia: A single‐center retrospective study in southern Taiwan

Abstract Achalasia is a rare esophageal motility disorder causing dysphagia, chest pain, vomiting, and weight loss, significantly impairing quality of life. Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive and effective treatment. However, limited data compare the outcomes of POEM between type I and type II achalasia based on the Chicago Classification. This single‐center retrospective study included patients diagnosed with achalasia (Eckardt score ≥4) who underwent POEM at Kaohsiung Chang Gung Memorial Hospital from December 2016 to May 2023. The Eckardt score was assessed 6 months after the POEM procedure, while the High‐Resolution Manometry had an average median follow‐up of 30.5 months. Primary outcomes included changes in Eckardt score, lower esophageal sphincter (LES) pressure, upper esophageal sphincter (UES) pressure, and integrated relaxation pressure. Secondary outcomes included hospital stay, operation time, weight gain, and adverse event rates. A total of 39 patients (17 with type I and 22 with type II achalasia) were analyzed, with a median follow‐up of 30.5 months. Both subtypes showed significant improvements in Eckardt scores ( p &lt; .001) and weight gain (type I: p = .023; type II: p = .03). No significant differences were observed between subtypes in Eckardt score reduction ( p = .458) or weight gain ( p = .693). Type II patients had shorter hospital stays ( p = .017). While LES pressure decreased significantly in type I patients after POEM ( p = .007), it did not reach statistical significance in type II patients ( p = .051). Our study demonstrated that POEM therapy effectively improves symptoms and facilitates weight gain in both type I and type II achalasia, with no significant differences in primary outcomes.