Achalasia Treatment Trials: POEM, Heller Myotomy and Balloon Dilation

Table of Contents

1. How the Trials Measure Success
2. Balloon Dilation Versus Heller Myotomy
3. Peroral Endoscopic Myotomy Versus Balloon Dilation
4. Peroral Endoscopic Myotomy Versus Heller Myotomy
5. Botulinum Toxin Versus Balloon Dilation
6. Results by Chicago Classification Subtype
7. Reflux After Each Treatment
8. Perforation and Other Harms
9. Repeat Treatment and Treatment After Failure
10. What the Network Meta-Analyses Found
11. What the 2020 American College of Gastroenterology Guideline States
12. Limits of the Evidence
13. Key Research Papers
14. Connections
15. Featured Videos

How the Trials Measure Success

Almost every trial on this page uses the same yardstick, the Eckardt score. It adds up four symptoms — trouble swallowing, food coming back up (regurgitation), chest pain behind the breastbone, and weight loss — on a scale from 0 to 12, where higher means worse. A trial usually counts a patient as a success when the score falls to 3 or less.

The small print matters, because the trials do not all define success the same way:

• The European Achalasia Trial counted success as an Eckardt score of 3 or less at each yearly check, and a second balloon dilation was allowed within the dilation arm.
• The trial of peroral endoscopic myotomy against balloon dilation counted any need for a further dilation, or a severe complication, as a failure. Dilation patients received one series of balloons (30 mm then 35 mm) and nothing more.
• The trial of peroral endoscopic myotomy against Heller myotomy counted success as a score of 3 or less without any additional treatment.

So a "success rate" for balloon dilation in one trial is not the same measurement as in another. Where this page puts numbers from different trials side by side, it says so: those are cross-trial comparisons, not head-to-head results.

Besides symptoms, trials measure the pressure in the muscle ring when it is meant to relax on swallowing (the integrated relaxation pressure, read on high-resolution manometry), and how fast a column of barium drains out of the food pipe on a timed X-ray (the timed barium esophagram).

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Balloon Dilation Versus Heller Myotomy

The European Achalasia Trial is the largest randomized trial of balloon dilation against laparoscopic Heller myotomy with a Dor fundoplication. It enrolled 201 newly diagnosed adults at centres in several European countries.

The 2-year results (Boeckxstaens 2011, New England Journal of Medicine)

• Study type: randomized controlled trial, 95 patients assigned to balloon dilation and 106 to Heller myotomy, mean follow-up 43 months.
• Success: balloon dilation 90% at 1 year and 86% at 2 years; Heller myotomy 93% at 1 year and 90% at 2 years. The difference was not statistically significant. Put the other way, about 14 in 100 dilation patients and 10 in 100 surgery patients had not reached success at 2 years.
• Muscle ring pressure at 2 years: 10 mm Hg after surgery and 12 mm Hg after dilation, not significantly different. Barium emptying and quality of life were also not significantly different.
• Harms: the food pipe was perforated in 4% of patients during dilation; the lining was torn during surgery (a mucosal tear) in 12%.
• Reflux: abnormal acid exposure was measured in 15% after dilation and 23% after surgery, not significantly different.

The 5-year results (Moonen 2016, Gut)

• In the full analysis set, success after 5 years was 84% after Heller myotomy and 82% after balloon dilation, not significantly different. Roughly 16 in 100 surgery patients and 18 in 100 dilation patients were no longer counted as successes.
• In the per-protocol analysis (patients who received the treatment as planned) the 5-year figures were 82% for surgery and 91% for dilation, also not significantly different.
• No differences in muscle ring pressure, esophageal function or emptying were found after 5 years.
• 25% of dilation patients (24 people) needed a repeat dilation during follow-up, which the trial allowed within the dilation strategy.
• Five perforations occurred during dilation (5%) and 12 mucosal tears during surgery (11%).
• The investigators concluded that either treatment can be proposed as initial treatment for achalasia.

This trial is the main evidence against the older belief that Heller myotomy gives clearly better long-term symptom control than balloon dilation. In this trial it did not, as long as repeat dilation was allowed.

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Peroral Endoscopic Myotomy Versus Balloon Dilation

The first randomized trial of peroral endoscopic myotomy against balloon dilation in people who had never been treated ran at six hospitals in the Netherlands, Germany, Italy, Hong Kong and the United States.

The 2-year results (Ponds 2019, JAMA)

• Study type: randomized controlled trial; 133 patients randomized (67 to peroral endoscopic myotomy, 66 to dilation with a 30 mm and a 35 mm balloon); 126 completed the study.
• Success at 2 years: 58 of 63 patients (92%) after peroral endoscopic myotomy versus 34 of 63 (54%) after dilation, a difference of 38 percentage points. Seen the other way, 8% of myotomy patients and 46% of dilation patients had failed by this trial's definition, which counted any further dilation as failure.
• Muscle ring pressure (9.9 versus 12.6 mm Hg) did not differ significantly. Median barium column height was 2.3 cm after myotomy and 0 cm after dilation.
• Reflux damage: reflux esophagitis (inflammation of the food pipe lining seen on endoscopy) was found in 22 of 54 myotomy patients (41%) versus 2 of 29 dilation patients (7%).
• Serious harms: two serious adverse events, including one perforation, after dilation; none after peroral endoscopic myotomy.

The 5-year results (Kuipers 2022, Lancet Gastroenterology and Hepatology)

• Success at 5 years: 50 of 62 (81%) after peroral endoscopic myotomy versus 25 of 63 (40%) after dilation, an adjusted difference of 41 percentage points. So about 19 in 100 myotomy patients and 60 in 100 dilation patients had failed by the trial's definition.
• Reasons for failure: no initial effect in 1 myotomy patient versus 12 dilation patients; recurrent symptoms in 11 myotomy patients versus 25 dilation patients.
• Among people still in remission, daily acid-suppressing medicine (proton pump inhibitors) was used by 46% (23 of 50) after myotomy versus 13% (3 of 24) after dilation.
• Reflux esophagitis on 5-year endoscopy: 33% (14 of 42) after myotomy, mostly mild grades A or B, with 2 patients (5%) at the severe grades C or D; 13% (2 of 16) after dilation. This difference was not statistically significant.
• No treatment-related serious adverse events occurred between years 2 and 5.
• The authors wrote that the result should not lead to abandoning balloon dilation and that treatment options are a shared decision.

The gap between this trial's dilation success (54% at 2 years, 40% at 5 years) and the European Achalasia Trial's (86% at 2 years, 82% at 5 years) is a cross-trial comparison. It largely reflects the different rules: the European trial allowed repeat dilation inside the dilation strategy, while this trial counted a repeat dilation as failure.

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Peroral Endoscopic Myotomy Versus Heller Myotomy

The main head-to-head trial of the two myotomies ran at eight centres in six European countries and compared peroral endoscopic myotomy with laparoscopic Heller myotomy plus Dor fundoplication.

The 2-year results (Werner 2019, New England Journal of Medicine)

• Study type: randomized non-inferiority trial; 221 patients treated (112 peroral endoscopic myotomy, 109 Heller myotomy). A non-inferiority trial asks whether the new procedure is no more than a set margin worse, here 12.5 percentage points.
• Success at 2 years: 83.0% after peroral endoscopic myotomy and 81.7% after Heller myotomy, a difference of 1.4 percentage points. Peroral endoscopic myotomy met the non-inferiority test. About 17 in 100 myotomy patients and 18 in 100 surgery patients were not successes.
• Serious adverse events: 2.7% after peroral endoscopic myotomy and 7.3% after Heller myotomy.
• Muscle ring pressure and quality-of-life scores improved similarly in both groups.
• Reflux esophagitis on endoscopy: at 3 months, 57% after peroral endoscopic myotomy and 20% after Heller myotomy; at 24 months, 44% and 29%.

The 5-year results (Hugova 2025, Lancet Gastroenterology and Hepatology)

• Of 241 randomized patients, 221 had the assigned procedure, and 5-year data were available for 90 after peroral endoscopic myotomy and 87 after Heller myotomy (80% of each group).
• Success at 5 years: 75.0% after peroral endoscopic myotomy and 70.8% after Heller myotomy, a difference of 4.2 percentage points. A quarter of myotomy patients and about 29 in 100 surgery patients were no longer successes.
• Reflux esophagitis at 5 years: 41% (26 of 63) after peroral endoscopic myotomy and 31% (18 of 58) after Heller myotomy. Significant esophagitis (grade B, C or D) was found in 14% (9 of 63) and 7% (4 of 58).
• Acid monitoring was done in only 81 of 221 patients. In them, abnormal acid exposure was found in 62% (28 of 45) after peroral endoscopic myotomy versus 31% (11 of 36) after Heller myotomy.
• Reflux symptoms at 5 years were similar in both groups.
• Peptic stricture, Barrett's esophagus and esophageal adenocarcinoma were not reported in either group.

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Botulinum Toxin Versus Balloon Dilation

Botulinum toxin blocks the nerve signal that keeps the muscle ring tight. A Cochrane systematic review (Leyden 2014) pooled seven randomized trials with 178 participants comparing it with balloon dilation.

• Within four weeks of treatment, remission was not significantly different between the two.
• At six months, 46 of 57 dilation patients (81%) were in remission compared with 29 of 56 botulinum toxin patients (52%).
• At twelve months, 55 of 75 dilation patients (73%) were in remission compared with 27 of 72 botulinum toxin patients (38%). In other words, about 62 in 100 people given botulinum toxin had relapsed or not responded by one year.
• No serious adverse outcomes occurred with botulinum toxin; dilation was complicated by perforation in three cases.
• The reviewers concluded that dilation was the more effective endoscopic treatment beyond six months.

Two network meta-analyses (below) reached the same conclusion from a larger set of trials: at one year, botulinum toxin gave lower success than each of the other treatments.

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Results by Chicago Classification Subtype

High-resolution manometry, which reads pressure all along the food pipe, splits achalasia into three subtypes (the Chicago Classification, described on the main achalasia page): type I, with almost no pressure in the food pipe body; type II, where the whole food pipe pressurizes at once; and type III, with spastic, premature contractions.

The original subtype study (Pandolfino 2008)

In this study of 99 newly diagnosed patients, found among 1,000 manometry studies (21 type I, 49 type II, 29 type III; 83 with enough follow-up), type II patients were significantly more likely to respond to any therapy: 71% to botulinum toxin, 91% to balloon dilation and 100% to Heller myotomy. Overall response was 56% in type I and 29% in type III. Type III and a widened food pipe before treatment predicted a poorer response. This was an observational study, not a trial.

Subtypes inside the European Achalasia Trial (Rohof 2013)

• Of 176 patients with manometry tracings, 25% were type I, 65% type II and 10% type III.
• After at least 2 years, success was 96% in type II, 81% in type I and 66% in type III.
• In type II, dilation succeeded in 100% and Heller myotomy in 93%, a significant difference.
• In type III, Heller myotomy succeeded in 86% and dilation in 40%. With only 18 type III patients, this difference did not reach statistical significance.
• In type I, the two were similar (81% surgery, 85% dilation).

These are subgroup analyses of a randomized trial; the trial was not designed to compare treatments within each subtype.

Pooled subtype data

• A meta-analysis of 20 studies with 1,575 patients (Andolfi 2019), mostly not randomized, reported Heller myotomy success of 81%, 92% and 71% in types I, II and III, and peroral endoscopic myotomy success of 95%, 97% and 93%. Peroral endoscopic myotomy was more likely to succeed than Heller myotomy in type I and type III, and similar in type II.
• A retrospective multicentre study of type III achalasia (Kumbhari 2015) compared 49 peroral endoscopic myotomy patients across eight centres with 26 Heller myotomy patients from one institution. Clinical response was 98.0% versus 80.8%; the myotomy was longer with the endoscopic approach (16 cm versus 8 cm); adverse events were 6% versus 27%. Because patients were not randomized and came from different centres, this cannot show cause and effect.
• A meta-analysis of 21 studies with 2,698 peroral endoscopic myotomy patients followed for at least 2 years (Zhang 2023) reported long-term success of 86.1% in type I, 87.9% in type II and 83.9% in type III.

The claim that peroral endoscopic myotomy works better than Heller myotomy in type III rests on these observational comparisons and the ability of the endoscopic cut to run further up the food pipe; it has not been tested in a randomized trial limited to type III.

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Reflux After Each Treatment

Opening the muscle ring lets food down, but it also lets stomach acid up. Peroral endoscopic myotomy adds no anti-reflux wrap, and the trials consistently find more reflux after it.

Reflux esophagitis on endoscopy, as each trial reports it

• Peroral endoscopic myotomy versus Heller myotomy with Dor fundoplication (Werner 2019; Hugova 2025): 57% versus 20% at 3 months; 44% versus 29% at 2 years; 41% versus 31% at 5 years.
• Peroral endoscopic myotomy versus balloon dilation (Ponds 2019; Kuipers 2022): 41% versus 7% at 2 years; 33% versus 13% at 5 years, among patients still in remission.
• Balloon dilation versus Heller myotomy (Boeckxstaens 2011): abnormal acid exposure on monitoring in 15% versus 23% at 2 years.

Pooled data

A meta-analysis of prospective studies (Repici 2018), covering 1,542 peroral endoscopic myotomy patients and 2,581 Heller myotomy patients with fundoplication, reported:

• Reflux symptoms: 19.0% after peroral endoscopic myotomy versus 8.8% after Heller myotomy.
• Abnormal acid exposure on pH monitoring: 39.0% versus 16.8%.
• Esophagitis: 29.4% versus 7.6%.

The long-term peroral endoscopic myotomy meta-analysis (Zhang 2023) put symptomatic reflux at 23.9% and reflux esophagitis at 16.7%.

Most esophagitis in these trials was graded mild (Los Angeles grade A or B). The gap between measured acid and symptoms is worth knowing: at 5 years after peroral endoscopic myotomy, abnormal acid exposure was found in 62% of those tested, yet reflux symptom scores were similar to the surgery group. Reflux damage can therefore be present without heartburn. Long-term reflux damage of the food pipe is the background to Barrett's esophagus; the 5-year trial found no cases of it, but 5 years is short for that question.

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Perforation and Other Harms

• Perforation during balloon dilation — a tear through the whole wall of the food pipe — is the main serious risk of that procedure. It occurred in 4% of dilation patients in the European Achalasia Trial at 2 years (5%, five patients, by the 5-year report), in one patient in the trial against peroral endoscopic myotomy, and in three cases across the Cochrane review's trials. The 2020 American College of Gastroenterology guideline gives an overall median rate in experienced hands of 1.9%, with a range of 0% to 16% across reports.
• Mucosal tears during Heller myotomy (a tear in the inner lining, normally repaired during the same operation) occurred in 12% at 2 years and 11% at 5 years in the European trial.
• Serious adverse events in the myotomy trial were 2.7% after peroral endoscopic myotomy and 7.3% after Heller myotomy. The balloon-dilation trial reported no serious adverse events after peroral endoscopic myotomy.
• Botulinum toxin was not associated with any serious adverse outcome in the Cochrane review.

The guideline describes the signs that teams watch for after dilation: pain, crepitus (a crackling feel under the skin) and fever. It notes that a perforation can show up later, after discharge, with severe chest pain with or without fever, and that every patient undergoing dilation is meant to be a candidate for surgery in case a perforation needs repair. A perforation of the food pipe is treated by hospitals as an emergency.

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Repeat Treatment and Treatment After Failure

• Balloon dilation: in the European Achalasia Trial, 25% of dilation patients needed redilation over 5 years. In the trial against peroral endoscopic myotomy, where any repeat dilation counted as failure, 60% of dilation patients had failed by 5 years.
• Peroral endoscopic myotomy: 19% had failed by 5 years in the trial against dilation; 25% were not counted as successes at 5 years in the trial against Heller myotomy.
• Heller myotomy: about 29% were not counted as successes at 5 years in the trial against peroral endoscopic myotomy, and 16% in the European trial against dilation (cross-trial figures with different definitions).

When Heller myotomy fails (Wessels 2026)

A randomized trial in the Netherlands, Belgium and Italy enrolled 90 people whose symptoms had come back after Heller myotomy, and assigned them to balloon dilation (30 to 35 mm) or peroral endoscopic myotomy. At 5 years, treatment success was 11% after dilation (5 of 45) and 40% after peroral endoscopic myotomy (18 of 45); put the other way, 89% and 60% had failed. Median time to failure was 12 months after dilation and 60 months after peroral endoscopic myotomy. Grade B to D reflux esophagitis was found in 11% and 9%. No procedure-related serious adverse events occurred between years 1 and 5.

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What the Network Meta-Analyses Found

A network meta-analysis combines direct trial comparisons (A against B) with indirect ones (A against C and B against C) to rank several treatments at once. Its results are only as good as the small trials feeding it.

• Beshr 2026 (14 randomized trials, 1,171 patients): at 1 year all treatments were more effective than botulinum toxin, and peroral endoscopic myotomy and Heller myotomy outperformed balloon dilation. At 2 and 5 years peroral endoscopic myotomy remained superior to dilation. Peroral endoscopic myotomy and Heller myotomy were comparable at every time point. At 5 years, reflux disease was less likely after dilation (risk ratio 0.35) and after Heller myotomy (risk ratio 0.49) than after peroral endoscopic myotomy. The authors rated the quality of the evidence low to very low.
• Morrison 2026 (15 randomized trials, 1,170 patients): botulinum toxin had significantly lower success at 1 year. At 5 years success was significantly greater after Heller myotomy and after peroral endoscopic myotomy. Balloon dilation left a higher muscle ring pressure and more abnormal acid exposure. Heller myotomy and peroral endoscopic myotomy showed comparable long-term efficacy, with a higher, non-significant rate of esophagitis after peroral endoscopic myotomy.
• Gong 2023 (27 randomized trials): an anterior variant of peroral endoscopic myotomy, then standard peroral endoscopic myotomy, ranked highest for relief of swallowing trouble in short-term follow-up, while peroral endoscopic myotomy ranked worst for reflux. Botulinum toxin ranked lowest for relief and had the lowest reflux rate.

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What the 2020 American College of Gastroenterology Guideline States

The American College of Gastroenterology clinical guideline on achalasia (Vaezi 2020) graded its statements with the GRADE system. The statements below are quoted as the guideline words them in its summary table, with the quality of evidence and strength it assigned (taken from the full text of the guideline). In the quotes, PD is pneumatic dilation, LHM laparoscopic Heller myotomy, POEM peroral endoscopic myotomy, LES the lower esophageal sphincter and GERD gastroesophageal reflux disease.

• "We recommend that PD or LHM are both effective and equivalent short- and long-term procedures for patients with achalasia who are candidates to undergo definitive therapy." — high quality, strong.
• "We suggest that POEM or PD result in comparable symptomatic improvement in patients with types I or II achalasia." — low quality, conditional.
• "We recommend that POEM and LHM result in comparable symptomatic improvement in patients with achalasia." — moderate quality, strong.
• "We recommend tailored POEM or LHM for type III achalasia as a more efficacious alternative disruptive therapy at the LES compared to PD." — moderate quality, strong.
• "We suggest that in patients with achalasia, POEM compared with LHM with fundoplication or PD is associated with a higher incidence of GERD." — moderate quality, strong.
• "We recommend LHM over botulinum toxin injection in patients with achalasia fit for surgery." — moderate quality, strong.
• "We recommend botulinum toxin injection as first-line therapy for patients with achalasia who are unfit for definitive therapies compared with other less effective pharmacological therapies." — moderate quality, strong.
• "We suggest that previous treatment with botulinum toxin injection does not significantly affect performance and outcomes of myotomy."
• "We recommend that PD is an appropriate and safe treatment option for patients with achalasia post-initial surgical myotomy or POEM in need of retreatment." — moderate quality, strong.
• "We suggest against routine endoscopic surveillance for esophageal carcinoma in patients with achalasia." — low quality, strong.

The guideline was written before the 5-year results of the two peroral endoscopic myotomy trials and the trial after failed Heller myotomy were published. In its text it notes that people who undergo peroral endoscopic myotomy may need lifelong acid suppression, and that screening for erosive esophagitis or Barrett's esophagus after the procedure may be prudent.

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Limits of the Evidence

• Few, mostly European trials. The head-to-head evidence rests on a handful of randomized trials of 90 to 241 patients, run at expert centres. Results at less experienced centres may differ.
• Different definitions of success. Whether a repeat dilation counts as part of the treatment or as a failure changes the dilation numbers by a wide margin.
• Subtype comparisons are small. The European trial had only 18 type III patients; most subtype data come from observational studies.
• Follow-up is short for cancer and Barrett's esophagus. No trial yet has the decades of follow-up needed to compare long-term reflux complications.
• Reflux testing was incomplete. In the 5-year myotomy trial, acid monitoring was done in only 37% of patients.
• Network meta-analyses rank treatments partly through indirect comparisons, and one rated its own evidence low to very low.

Decisions about which procedure fits a given person, with their subtype, age and other illnesses, belong with the treating team.

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Key Research Papers

1. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807-16. PubMed PMID: 21561346
2. Moonen A, Annese V, Belmans A, Bredenoord AJ, Bruley des Varannes S, Costantini M, et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016;65(5):732-9. PubMed PMID: 26614104
3. Rohof WO, Salvador R, Annese V, Bruley des Varannes S, Chaussade S, Costantini M, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144(4):718-25. PubMed PMID: 23277105
4. Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135(5):1526-33. PubMed PMID: 18722376
5. Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, et al. Effect of Peroral Endoscopic Myotomy vs Pneumatic Dilation on Symptom Severity and Treatment Outcomes Among Treatment-Naive Patients With Achalasia: A Randomized Clinical Trial. JAMA. 2019;322(2):134-144. PubMed PMID: 31287522
6. Kuipers T, Ponds FA, Fockens P, Bastiaansen BAJ, Lei A, Oude Nijhuis RAB, et al. Peroral endoscopic myotomy versus pneumatic dilation in treatment-naive patients with achalasia: 5-year follow-up of a randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(12):1103-1111. PubMed PMID: 36206786
7. Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019;381(23):2219-2229. PubMed PMID: 31800987
8. Hugova K, Mares J, Hakanson B, Repici A, von Rahden BHA, Bredenoord AJ, et al. Per-oral endoscopic myotomy versus laparoscopic Heller's myotomy plus Dor fundoplication in patients with idiopathic achalasia: 5-year follow-up of a multicentre, randomised, open-label, non-inferiority trial. Lancet Gastroenterol Hepatol. 2025;10(5):431-441. PubMed PMID: 40112837
9. Wessels EM, Masclee GMC, Bastiaansen BAJ, Saleh CMC, Tack J, Boeckxstaens G, et al. Long-Term Outcomes of Peroral Endoscopic Myotomy vs Pneumatic Dilation After Prior Laparoscopic Heller Myotomy for Achalasia. Clin Gastroenterol Hepatol. 2026;24(7):1812-1822. PubMed PMID: 41932531
10. Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev. 2014;2014(12):CD005046. PubMed PMID: 25485740
11. Repici A, Fuccio L, Maselli R, Mazza F, Correale L, Mandolesi D, et al. GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc. 2018;87(4):934-943.e18. PubMed PMID: 29102729
12. Andolfi C, Fisichella PM. Meta-analysis of clinical outcome after treatment for achalasia based on manometric subtypes. Br J Surg. 2019;106(4):332-341. PubMed PMID: 30690706
13. Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015;3(3):E195-201. PubMed PMID: 26171430
14. Zhang H, Zeng X, Huang S, Shi L, Xia H, Jiang J, et al. Mid-Term and Long-Term Outcomes of Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2023;68(4):1386-1396. PubMed PMID: 36260203
15. Beshr MS, Hayek MA, Nounou MV, Elhadi M, Mori Y, Facciorusso A, et al. Comparative Effectiveness of Peroral Endoscopic Myotomy, Laparoscopic Heller Myotomy, Pneumatic Dilation, and Botulinum Toxin for Achalasia: A Network Meta-Analysis. J Clin Gastroenterol. 2026 (online ahead of print). PubMed PMID: 42296412
16. Morrison JP, Davey MG, Donlon NE. Evaluating surgical management of primary achalasia-a systematic review and network meta-analysis of randomized clinical trials. J Gastrointest Surg. 2026;30(10):102558. PubMed PMID: 42617727
17. Gong F, Li Y, Ye S. Effectiveness and complication of achalasia treatment: A systematic review and network meta-analysis of randomized controlled trials. Asian J Surg. 2023;46(1):24-34. PubMed PMID: 35484068
18. Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115(9):1393-1411. PubMed PMID: 32773454

PubMed Topic Searches

1. PubMed: peroral endoscopic myotomy randomized trials in achalasia
2. PubMed: balloon dilation versus Heller myotomy trials
3. PubMed: achalasia subtype and treatment outcome
4. PubMed: reflux after achalasia myotomy

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Connections

• Achalasia — the main page: causes, subtypes, symptoms and diagnosis
• Gastroenterology — the digestive diseases category
• Dysphagia (Difficulty Swallowing) — the symptom these treatments target
• Gastroesophageal Reflux Disease (GERD) — the main side effect after myotomy
• Barrett's Esophagus — the long-term reflux change follow-up looks for
• Esophageal Cancer — the cancer risk in long-standing achalasia
• Chagas Disease — the parasitic cause of an achalasia-like food pipe
• Peristalsis: How Food Actually Moves Through You — the movement achalasia loses

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