BACKGROUND: Although laparoscopic Heller myotomy (LHM) has been the standard of 
care for achalasia, per oral endoscopic myotomy (POEM) has gained popularity as 
a viable alternative. This retrospective study aimed to compare patient-reported 
outcomes between LHM and POEM in a consecutive series of achalasia patients with 
more than 1 year of follow-up.
STUDY DESIGN: We reviewed demographic and procedure-related data for patients 
who underwent either LHM or POEM for achalasia between January 2011 and May 
2016. Phone interviews were conducted assessing post-procedure achalasia 
symptoms via the Eckardt score and achalasia severity questionnaire (ASQ). 
Demographics, disease factors, and survey results were compared between LHM and 
POEM patients using univariate analysis. Significant predictors of procedure 
failure were analyzed using univariate and multivariate analysis.
RESULTS: There were no serious complications in 110 consecutive patients who 
underwent LHM or POEM during the study period, and 96 (87%) patients completed 
phone surveys. There was a nonsignificant trend toward better patient-reported 
outcomes with POEM. There were significant differences in patient 
characteristics including sex, achalasia type, mean residual lower esophageal 
pressure (rLESP), and follow-up time. The only univariate predictors of an 
unsatisfactory Eckardt score or ASQ were longer follow-up and lower rLESP, with 
follow-up length being the only predictor on multivariate analysis.
CONCLUSIONS: There were significant demographic and clinical differences in 
patient selection for POEM vs LHM in our group. Although the 2 procedures have 
similar patient-reported effectiveness, subjective outcomes seem to decline as a 
result of time rather than procedure type.