The efficacy of POEM treatment varies significantly in patients with different types of pancreatic achalasia. There are three pressure types of cardia achalasia, each with lower sphincter pressure greater than or equal to 15 mmHg, in addition to type I showing 100% ineffective esophageal peristalsis, type II showing more than 20% of swallowing with visible esophageal pressure increase, and type III showing more than 20% of swallowing with phasic early contraction of the lower esophagus. Among them, type II is more common and has the best effect after treatment, followed by type I and least type III, and the treatment effect of type I and III is poor. Therefore making an accurate esophageal pressure typing before treatment can predict the efficacy after treatment. In addition, according to the patients with different typing, appropriate distinction should be made in the length of muscle incision, especially type III patients must have adequate length of incision, and may have better postoperative efficacy. Therefore, it is recommended that it is necessary for patients to do esophageal manometry before endoscopic treatment of cardia loss, so that the doctor has a more adequate reference basis.