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Updated: May 6, 2026
Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic
Neil H Bhayani1, Ashwin A Kurian, Christy M Dunst
1*Division of Gastrointestinal and Minimally Invasive Surgery, Portland †Oregon Health & Sciences University, Portland.
Insights
Per-oral endoscopic myotomy (POEM) offers shorter hospital stays for achalasia patients compared to laparoscopic Heller myotomy (HM). Both treatments provide similar symptom relief and physiological improvements, with comparable safety profiles.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Endoscopic Procedures
Background:
- Achalasia is a primary esophageal motility disorder.
- Laparoscopic Heller myotomy (HM) with partial fundoplication is the traditional surgical standard.
- Per-oral endoscopic myotomy (POEM) presents a less invasive endoscopic alternative.
Purpose of the Study:
- To compare symptomatic and objective outcomes between HM and POEM for achalasia treatment.
- To evaluate the safety and efficacy of POEM relative to HM.
Main Methods:
- Retrospective analysis of consecutive achalasia patients undergoing HM or POEM between 2007 and 2012.
- Primary outcome: swallowing function assessed at 1 and 6 months post-surgery.
- Secondary outcomes: operative time, complications, and postoperative gastro-esophageal reflux disease (GERD).
Main Results:
- POEM procedures demonstrated significantly shorter operative times (120 min vs. 149 min) and hospitalizations (1.1 days vs. 2.2 days) compared to HM.
- One-month symptom scores (Eckardt) were significantly better after POEM (0.8 vs. 1.8). At 6 months, both groups showed sustained, similar improvements.
- Both techniques improved lower esophageal sphincter function; POEM resulted in higher postmyotomy resting pressures. Postoperative abnormal acid exposure rates were comparable (39% POEM vs. 32% HM).
Conclusions:
- Per-oral endoscopic myotomy (POEM) is an effective endoscopic treatment for achalasia, associated with reduced hospitalization compared to laparoscopic Heller myotomy (HM).
- Both POEM and HM yield comparable improvements in patient symptoms and esophageal physiology.
- POEM is a safe and effective alternative to HM for achalasia management, with similar rates of postoperative esophageal acid exposure.
Objective:
To compare symptomatic and objective outcomes between HM and POEM.
Background:
The surgical gold standard for achalasia is laparoscopic Heller myotomy (HM) and partial fundoplication. Per-oral endoscopic myotomy (POEM) is a less invasive flexible endoscopic alternative. We compare their safety and efficacy.
Methods:
Data on consecutive HMs and POEMs for achalasia from 2007 to 2012 were collected.
Primary Outcomes:
swallowing function-1 and 6 months after surgery.
Secondary Outcomes:
operative time, complications, postoperative gastro-esophageal reflux disease (GERD).
Results:
There were 101 patients: 64 HMs (42% Toupet and 58% Dor fundoplications) and 37 POEMs. Presenting symptoms were comparable. Median operative time (149 vs 120 min, P < 0.001) and mean hospitalization (2.2 vs 1.1 days, P < 0.0001) were significantly higher for HMs. Postoperative morbidity was comparable. One-month Eckardt scores were significantly better for POEMs (1.8 vs 0.8, P < 0.0001). At 6 months, both groups had sustained similar improvements in their Eckardt scores (1.7 vs 1.2, P = 0.1).Both groups had significant improvements in postmyotomy lower esophageal sphincter profiles. Postmyotomy resting pressures were higher for POEMs than for HMs (16 vs 7.1 mm Hg, P = 0.006). Postmyotomy relaxation pressures and distal esophageal contraction amplitudes were not significantly different between groups. Routine postoperative 24-hour pH testing was obtained in 48% Hellers and 76% POEMs. Postoperatively, 39% of POEMs and 32% of HM had abnormal acid exposure (P = 0.7).
Conclusions:
POEM is an endoscopic therapy for achalasia with a shorter hospitalization than HM. Patient symptoms and esophageal physiology are improved equally with both procedures. Postoperative esophageal acid exposure is the same for both. The POEM is comparable with laparoscopic HM for safe and effective treatment of achalasia.
