New risk scoring for achalasia post-POEM reveals critical patterns.

• The JAMS POEM score effectively predicts short-term clinical failure (AUROC 0.71) but loses accuracy long-term (AUROC 0.54).
• A three-tiered risk stratification identifies an intermediate-risk group with a 10-year failure rate of 35.8%, suggesting different follow-up strategies.

Surgeons should consider long-term outcomes when applying the JAMS POEM score for better patient surveillance.

• In the low-risk group, failure rates are stable at 29.1%, while high-risk patients face early failures at 37.5%.