Is peroral endoscopic myotomy (POEM) ready to replace laparoscopic Heller’s myotomy for achalasia? —comments on a recent systematic review

Achalasia is a motility disorder of the esophagus for which the standard treatment for at least the past decade has been laparoscopic Heller’s cardiomyotomy (HM) (1). For such a relatively uncommon disorder, it has nonetheless been extensively discussed in the literature in recent years. Firstly, the widespread adoption of high resolution manometry assessment of the esophagus has allowed classification of the disorder into clinical relevant subtypes (2). At approximately the same time, techniques of so-called “natural orifice” transluminal endoscopic surgery were being developed, with incision-free operations starting to be performed through the mouth and other sites (3). Eventually, in 2010, the first reports emerged of peroral endoscopic myotomy (POEM) for achalasia (4).