Health condition
POEM vs Heller myotomy
POEM (peroral endoscopic myotomy) and laparoscopic Heller myotomy are the two definitive muscle-cutting treatments for achalasia; both work extremely well, and choosing between them turns on achalasia subtype, reflux trade-offs and local expertise.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key points
What matters most, at a glance.
The essentials in plain English - symptoms, when to seek help, who to see and what treatment looks like.
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Both procedures cut the tight lower oesophageal muscle; POEM works from inside via endoscopy, Heller through keyhole abdominal surgery
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Success rates are comparable and high - around nine in ten patients gain lasting relief
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POEM can extend the cut higher, an advantage in type III (spastic) achalasia
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Heller is usually paired with a partial anti-reflux wrap, so post-procedure reflux is less frequent than after POEM
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After POEM, many patients need long-term acid suppression and surveillance for reflux complications
Understanding it
About POEM vs Heller myotomy, and what to do next.
The decision is a genuine trade-off rather than a ranking. POEM is incisionless, allows a tailored myotomy length and suits spastic subtypes and redo treatment; its main downside is a higher rate of acid reflux because no anti-reflux barrier is fashioned. Heller myotomy adds a fundoplication in the same operation, at the cost of abdominal keyhole surgery.
High-resolution manometry findings, prior treatments, reflux risk factors and personal priorities all feed the choice, and units performing both at volume report excellent outcomes with either. A structured consultation reviewing your manometry subtype is the right starting point. Most people start with their GP, who can refer to a consultant gastroenterologist or upper-GI surgeon at a centre offering both procedures. In many parts of the UK, routine NHS referrals for this kind of problem currently take 20-45+ weeks, whereas an initial private consultation is typically available within around two weeks.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any emergency symptoms described above.
Frequently asked
Common questions about POEM vs Heller myotomy.
Quick, plain-English answers to what people ask us most.
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What are POEM and Heller myotomy?
Both are procedures used to treat achalasia, a condition where the muscle at the bottom of the food pipe fails to relax properly, causing difficulty swallowing. POEM is an endoscopic (through the mouth) technique, while Heller myotomy is a surgical procedure, usually performed laparoscopically.
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What causes achalasia, the condition these procedures treat?
Achalasia results from damage to the nerves controlling the lower oesophageal sphincter, preventing it from relaxing normally during swallowing, though the exact underlying cause of this nerve damage often isn't clear.
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What are the symptoms of achalasia?
Difficulty swallowing both solids and liquids, regurgitation of undigested food, chest discomfort, and weight loss are typical symptoms that both POEM and Heller myotomy aim to relieve.
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How do POEM and Heller myotomy differ?
POEM is performed via an endoscope through the mouth without external incisions, generally allowing quicker recovery, while Heller myotomy is a laparoscopic surgical procedure often combined with an anti-reflux procedure at the same time, which POEM typically doesn't include.
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Which is more effective, POEM or Heller myotomy?
Both have shown good effectiveness in relieving swallowing symptoms in studies, with broadly similar success rates; the choice often depends on the specific pattern of achalasia, surgeon experience, and individual patient factors.
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What are the risks of these procedures?
Both carry risks including reflux (potentially more common after POEM, since it doesn't typically include an anti-reflux procedure), and general procedural risks such as bleeding or, rarely, perforation.
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How long does recovery take after each procedure?
POEM often allows a shorter hospital stay and quicker return to normal eating, sometimes within days, while Heller myotomy, though also increasingly done via minimally invasive surgery, may involve a slightly longer initial recovery.
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Will I need long-term follow-up after treatment for achalasia?
Yes, regular follow-up is recommended after either procedure to monitor for symptom recurrence and manage any reflux that develops, particularly important after POEM given the higher reported reflux rates.
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How is achalasia diagnosed before choosing a treatment?
Diagnosis typically involves a barium swallow test, endoscopy, and manometry (a test measuring pressure and movement in the oesophagus), which also helps determine which procedure might suit your specific pattern of achalasia best.
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When should I see a specialist, and how quickly can I be seen privately?
See a gastroenterology or upper GI surgical specialist for suspected achalasia. Private specialist assessment, including diagnostic testing, is typically available within about two weeks, considerably faster than standard NHS referral pathways.