To determine whether per-oral endoscopic myotomy (POEM) improves esophageal peristalsis and investigate the association between the presence of peristalsis after POEM and clinico-physiological features.
In a single center retrospective study, data were gathered from patients with achalasia who underwent POEM between January 2014 and May 2016. Parameters of high-resolution esophageal manometry, demographics data, Eckardt score and post-procedural gastroesophageal reflux disease questionnaire (GERD-Q) score were collected. Presence of weak and fragmented contraction was defined as partial recovery of esophageal peristalsis based on Chicago classification v3.0. Logistic regression analysis was used to study variables associated with partial recovery of peristalsis after POEM.
A total of 103 patients were enrolled. Esophageal contractile activity was observed in the distal two-thirds of the esophagus in 24 patients. The Eckardt score, integrated relaxation pressure (IRP) and lower esophageal sphincter (LES) resting pressure were significantly decreased after POEM. Univariate analyses revealed the correlation between preprocedural LES resting pressure as well as weight loss score, reflux score, Eckardt score and peristaltic recovery (all P < 0.05). Via multivariate analysis, preprocedural LES resting pressure (P = 0.013) and preprocedural Eckardt score (P = 0.002) were correlated with peristalsis recovery. Symptoms of gastroesophageal reflux and reflux esophagitis after POEM were less frequent in those with partial recovery of peristalsis (all P < 0.05).
Normalization of esophagogastric junction relaxation pressure achieved by POEM is associated with partial recovery of esophageal peristalsis in some patients. Preprocedural LES resting pressure and symptom score are predictive of the peristalsis recovery which prevents GERD symptoms and reflux esophagitis.

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