Peroral endoscopic myotomy (POEM) can be safely and effectively used to treat patients with achalasia who don’t respond to Heller myotomy, suggests a retrospective cohort study of 180 patients from 13 tertiary centers.

• POEM was technically effective in 98% of patients who had previously undergone Heller myotomy and all patients who had not undergone Heller myotomy.
• Patients who had experienced Heller myotomy responded less well to POEM than those who hadn’t undergone the procedure (81% vs 94%; P=.01).
• Adverse effects of both procedures were about the same (8% vs 13% in non-HM group; P=.23)
• After POEM was performed, there was also no significant difference in the incidence of symptomatic reflux or reflux esophagitis.