AIMS AND OBJECTIVES: Laparoscopic Heller myotomy (LHM) is the preferred surgical 
method for treating achalasia. However, peroral endoscopic myotomy (POEM) is 
providing good short-term results. The objective of this systematic review and 
meta-analysis was to compare the safety and efficacy of LHM and POEM.
MATERIALS AND METHODS: A search of PubMed, Cochrane database, Medline, Embase, 
Science Citation Index, and current contents for English-language articles 
comparing LHM and POEM between 2007 and 2016 was performed. Variables analyzed 
included prior endoscopic treatment, prior medical treatment, prior Heller 
myotomy, operative time, overall complications rate, postoperative 
gastroesophageal reflux disease (GERD), length of hospital stay, postoperative 
pain score, and long-term GERD.
RESULTS: Seven trials consisting of 483 (LHM=250, POEM=233) patients were 
analyzed. Preoperative variables, for example, prior endoscopic treatment [odds 
ratio (OR), 1.32; 95% confidence interval (CI), 0.23-4.61; P=0.96], prior 
medical treatment [weighted mean difference (WMD), 1.22; 95% CI, 0.52-2.88; 
P=0.65], and prior Heller myotomy (WMD, 0.47; 95% CI, 0.13-1.67; P=0.25) were 
comparable. Operative time was 26.28 minutes, nonsignificantly longer for LHM 
(WMD, 26.28; 95% CI, -11.20 to 63.70; P=0.17). There was a comparable overall 
complication rate (OR, 1.25; 95% CI, 0.56-2.77; P=0.59), postoperative GERD rate 
(OR, 1.27; 95% CI, 0.70-2.30; P=0.44), length of hospital stay (WMD, 0.30; 95% 
CI, -0.24 to 0.85; P=0.28), postoperative pain score (WMD, -0.26; 95% CI, -1.58 
to 1.06; P=0.70), and long-term GERD (WMD, 1.06; 95% CI, 0.27-4.1; P=0.08) for 
both procedures. There was a significantly higher short-term clinical treatment 
failure rate for LHM (OR, 9.82; 95% CI, 2.06-46.80; P<0.01).
CONCLUSIONS: POEM compares favorably to LHM for achalasia treatment in 
short-term perioperative outcomes. However, there was a significantly higher 
clinical treatment failure rate for LHM on short-term postoperative follow-up. 
Presently long-term postoperative follow-up data for POEM beyond 1 year are 
unavailable and eagerly awaited.