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The OBJECTIVE of the study was to evaluate the severity of submucosal fibrosis in patients with esophageal achalasia, its influence on technical and clinical success of peroral endoscopic myotomies (POEM), and their results.METHODS AND MATERIALS. The study included 116 patients with esophageal achalasia who underwent POEM in the Clinic of the Pavlov First Saint Petersburg State Medical University from June 2015 to March 2019. The mean age of patients was 50 years. It included 42 men and 74 women. This research was based on the retrospective analysis of video recordings of 116 POEM that were performed on patients with esophageal achalasia at the Endoscopy Department at the Pavlov First Saint Petersburg State Medical University.RESULTS. The mean operation time was 89.6 minutes. During the operation, changes in the esophageal mucosa were recorded in all patients, which were classified according to the esophageal mucosa in achalasia (EMIA), and during creating the tunnel, the severity of submucosal fibrosis (SMF) was evaluated according to the three-stage classification (SMF from 0 to 3 stage). We found out that SMF-1 occurred in 20 patients, SMF-2 occurred in 44 patients and SMF-3 occurred in 48 patients; we identified a new group of severe submucosal fibrosis – 3b that accompanied in our study by the highest 25 % frequency of mucosal perforation during surgery.CONCLUSION. The submucosal fibrosis of various SMF grades was determined intraoperatively in the majority of the patients and affected the POEM duration and complications.