Tassi V, et al. - Researchers sought the risk factors for oesophageal achalasia, a precancerous condition that can lead to epidermoid carcinoma. Among the considered 583 patients presenting with achalasia, 17 epidermoid carcinomas and 1 carcinosarcoma were diagnosed during a median follow-up time of 147.13 months (interquartile range 70.42–257.82 months). Risk factors for cancer included the sigmoid esophagus, duration of achalasia symptoms >280 months, duration of follow-up >353 months, oesophageal diameter at diagnosis >71 mm, residual barium column at diagnosis >23 cm and residual barium column at the last follow-up >10 cm. Conversely, lower risk of epidermoid carcinoma was evident when the residual barium swallow decreased by >57%. They suggest a possible positive influence of an effective Heller myotomy on the carcinogenetic process.