The latest advice from the American Gastroenterological Association (AGA) on the use of per-oral endoscopic myotomy includes the following recommendations:

• Practitioners should consider patient-specific parameters when attempting to assess the need for achalasia therapy, including Chicago Classification subtype, the presence of co-existing disorders, whether the patient has early or late disease, and whether there are primary or secondary causes involved.
• Per-oral endoscopic myotomy is a complex procedure that should be performed by experienced physicians in high volume treatment centers who have had an estimated 20-40 procedures under their belt.
• Per-oral endoscopic myotomy should be viewed as primary therapy among patients with type III achalasia, assuming the physician has adequate experience.