BACKGROUND AND AIM: This retrospective cohort study compared clinical outcomes 
and quality of life after peroral endoscopic myotomy (POEM) against laparoscopic 
Heller myotomy (LHM) for treatment of achalasia.
METHODS: Patient demographics, operation time, intraoperative blood loss, 
hospital stay, time to resume diet and analgesic requirement were recorded. 
Clinical outcomes including recurrence of dysphagia, need for reintervention, 
and occurrence of gastroesophageal reflux disease (GERD) were recorded.
RESULTS: From 2001 to 2014, 33 patients underwent POEM whereas 23 patients 
received LHM. Patients LHM had with longer mean operative time (P = 0.02), more 
blood loss (P = 0.001) and higher requirement for analgesics (P = 0.009) than 
those treated by POEM. Hospital stay and time to resume diet were similar. Both 
POEM and LHM achieved similar dysphagia scores at postoperative 4 weeks, 3 
months and 6 months. Twenty-six percent of LHM patients and 15.2% of POEM 
patients sustained gastroesophageal reflux disease (GERD) after treatment 
(P = 0.311). Six patients required regular proton pump inhibitor three after 
POEM and three after LHM (P = 0.639). Thirteen percent of LHM patients sustained 
recurrent dysphagia and one required reintervention. There was no recurrence in 
the POEM group. Follow-up duration (mean [SD]) for the LHM group was 
significantly longer (60 [42] months vs 6 [4] months; P = 0.001). There was also 
no difference in all four aspects of GERD-related quality of life outcomes.
CONCLUSION: Compared to LHM, POEM achieved shorter operative time, less blood 
loss and pain. POEM is comparable to LHM for treatment of achalasia with similar 
incidence of GERD after the procedure.