The potential of reduction in LES relaxation pressure during endoscopy in three cases of Achalasia

Aim Current high-resolution manometry (HRM) guidelines specify that manometry should be performed following esophagogastroduodenoscopy (EGD) but do not define an optimal interval between procedures. To investigate whether the timing of HRM relative to EGD influences diagnostic metrics for achalasia. Methods We unexpectedly discovered and analyzed three cases of suspected achalasia where the initial HRM, performed shortly after EGD, failed to meet diagnostic criteria. All patients subsequently underwent a repeat HRM several days after the initial EGD. Results In all three patients, the follow-up HRM studies demonstrated a significant increase in integrated relaxation pressure (IRP), with values reaching the definitive diagnostic threshold for achalasia, which were not observed in the initial studies. Conclusions The timing of HRM after EGD can affect IRP measurements and potentially impact diagnostic accuracy for achalasia. We recommend a delay of at least 3 days between EGD and HRM when achalasia is suspected to improve diagnostic yield.