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This review examines the rapidly developing evidence comparing peroral endoscopic myotomy (POEM) with laparoscopic Heller myotomy for achalasia. It places POEM in the context of the established surgical approach and discusses where the techniques overlap and where their risk-benefit profiles differ. A central clinical point is that both procedures aim to relieve functional obstruction by dividing the lower esophageal sphincter, but POEM achieves access from within the esophageal lumen and can be particularly attractive when a longer myotomy is needed. The trade-off is the possibility of postoperative reflux, which requires attention during follow-up. For surgeons, the article is useful because it reframes POEM not as a simple replacement for Heller myotomy but as another therapeutic pathway whose suitability depends on patient anatomy, disease phenotype, previous treatment and local expertise. In multidisciplinary centers, informed choice can therefore involve surgeons and advanced endoscopists rather than a single procedural specialty. The review supports thoughtful procedure selection and reinforces the value of long-term symptom and reflux assessment.
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This review examines the rapidly developing evidence comparing peroral endoscopic myotomy (POEM) with laparoscopic Heller myotomy for achalasia. It places POEM in the context of the established surgical approach and discusses where the techniques overlap and where their risk-benefit profiles differ. A central clinical point is that both procedures aim to relieve functional obstruction by dividing the lower esophageal sphincter, but POEM achieves access from within the esophageal lumen and can be particularly attractive when a longer myotomy is needed. The trade-off is the possibility of postoperative reflux, which requires attention during follow-up. For surgeons, the article is useful because it reframes POEM not as a simple replacement for Heller myotomy but as another therapeutic pathway whose suitability depends on patient anatomy, disease phenotype, previous treatment and local expertise. In multidisciplinary centers, informed choice can therefore involve surgeons and advanced endoscopists rather than a single procedural specialty. The review supports thoughtful procedure selection and reinforces the value of long-term symptom and reflux assessment.
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