Laparoscopic vs. Endoscopic Therapy for Achalasia

The gold standard surgical treatment for achalasia has been esophageal myotomy with partial fundoplication. Since being introduced in 2010, peroral endoscopic myotomy (POEM) has rapidly emerged as a wholly endoscopic single-stage option that has gained widespread adoption in treating achalasia. Results of recently published systematic reviews and meta-analyses demonstrate that the rates of reflux are higher in patients who undergo POEM, while POEM results in a slightly better clinical response with no difference in adverse events. We make a weak recommendation for POEM over laparoscopic myotomy with fundoplication for management of achalasia.