To explore the associations between lesion severity and lesion location, prior treatment history of achalasia (AC) in patients with AC combined with esophageal neoplastic lesions, and provide evidence for risk stratification and endoscopic surveillance of AC patients.

A single-center retrospective study enrolled patients diagnosed with AC combined with esophageal neoplastic lesions hospitalized in Chinese PLA General Hospital from January 2014 to December 2023.Patients were divided into prior AC treatment group and non-prior AC treatment group based on whether AC intervention was performed before lesion detection.Esophageal lesions were dichotomized into low-grade lesions (low-grade intraepithelial neoplasia, LGIN) and high-grade/invasive lesions(high-grade intraepithelial neoplasia HGIN/Tis+ invasive esophageal cancer).Fisher′s exact test was used to compare categorical variables; independent sampletest or Mann-Whitney U test was adopted for measurement data according to data distribution.Two-sided P<0.05 indicated exploratory statistically significant difference.

A total of 18 eligible patients were enrolled, including 5 cases of LGIN, 2 cases of HGIN/Tis, and 11 cases of invasive esophageal cancer. Nine patients had received AC intervention (prior AC treatment group), and 9 had no AC treatment history (non-prior AC treatment group).Lesions in prior AC treatment group were predominantly located in the lower esophagus (77.8%), including 5 LGIN and 4 HGIN/Tis or invasive cancer.Lesions in non-prior AC treatment group mostly occurred in the middle esophagus (66.7%), all presented as HGIN/Tis or invasive esophageal cancer with an esophageal dilatation rate of 88.9%.Distribution differences between groups: lesion location Fisher P=0.036, prior AC treatment Fisher P=0.029, esophageal dilatation Fisher P=0.099.No obvious distribution difference was observed between dysphagia duration and lesion severity.

Exploratory distribution differences exist between lesion severity and lesion location, prior AC treatment history in AC patients with esophageal neoplastic lesions. Lesions in lower esophagus or patients with AC intervention history are mostly low-grade intraepithelial neoplasia, while patients with middle esophageal lesions and without AC treatment are prone to high-grade and invasive lesions.Long-term endoscopic surveillance is recommended for AC patients with long disease duration, middle esophageal mucosal abnormalities, advanced age, male gender and alcohol drinking history.