An Exploratory Endoscopic Achalasia Phenotype With Visible Squamocolumnar Junction and Distal Esophagogastric Junction Relaxation Failure: Association With Gastroesophageal Reflux Disease After Peroral Endoscopic Myotomy (With Video)

Esophageal achalasia is typically defined by impaired lower esophageal sphincter (LES) relaxation. In rare cases, complete circumferential visibility of the squamocolumnar junction (SCJ) and upper gastric folds (GFs) is seen endoscopically, suggesting functional obstruction may extend to the distal esophagogastric junction rather than being confined to the LES. Such cases appear to be associated with a high risk of gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM). We clarified the characteristics and significance of this rare endoscopic phenotype.