BACKGROUND AND STUDY AIMS: Type III achalasia is characterized by rapidly 
propagating pressurization attributable to spastic contractions. Although 
laparoscopic Heller myotomy (LHM) is the current gold standard management for 
type III achalasia, peroral endoscopic myotomy (POEM) is conceivably superior 
because it allows for a longer myotomy. Our aims were to compare the efficacy 
and safety of POEM with LHM for type III achalasia patients.
PATIENTS AND METHODS: A retrospective study of 49 patients who underwent POEM 
for type III achalasia across eight centers were compared to 26 patients who 
underwent LHM at a single institution. Procedural data were abstracted and pre- 
and post-procedural symptoms were recorded. Clinical response was defined by 
improvement of symptoms and decrease in Eckardt stage to ≤ 1. Secondary outcomes 
included length of myotomy, procedure duration, length of hospital stay, and 
rate of adverse events.
RESULTS: Clinical response was significantly more frequent in the POEM cohort 
(98.0 % vs 80.8 %; P = 0.01). POEM patients had significantly shorter mean 
procedure time than LHM patients (102 min vs 264 min; P < 0.01) despite longer 
length of myotomy (16 cm vs 8 cm; P < 0.01). There was no significant difference 
between POEM and LHM in the length of hospital stay (3.3 days vs 3.2 days; 
P = 0.68), respectively. Rate of adverse events was significantly less in the 
POEM group (6 % vs 27 %; P < 0.01).
CONCLUSIONS: POEM allows for a longer myotomy than LHM, which may result in 
improved clinical outcomes. POEM appears to be an effective and safe alternative 
to LHM in patients with type III achalasia.