Concierge upper GI surgery · UK
Private laparoscopic Heller myotomy and POEM for achalasia, by a consultant upper GI surgeon.
A definitive treatment for achalasia — laparoscopic Heller with a Dor fundoplication, POEM in specialist centres, or pneumatic dilatation when it fits. The right choice hinges on your manometry subtype, and we say which before you commit.
Why patients choose us
- 01
A consultant upper GI surgeon, in theatre
Not a general list and not a training case. A named upper GI surgeon experienced in achalasia, a proper theatre, and intraoperative endoscopy every time.
- 02
Heller, POEM or balloon — honestly weighed
For some patients POEM is better; for others laparoscopic Heller wins on reflux control. We say which fits your manometry before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private achalasia treatment costs in the UK.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
Laparoscopic Heller myotomy in our network: £8,000–£14,000, home in one to two nights.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Laparoscopic Heller myotomy + Dor fundoplication | £8,000–£14,000 | 90–180 min GA | 1–2 night stay |
| POEM (per-oral endoscopic myotomy) | £6,000–£10,000 | 60–120 min GA | 1–2 night stay |
| Pneumatic balloon dilatation (per session) | £400–£800 | 30 min sedation | Same day |
| Botulinum toxin injection (EGD) | £800–£1,600 | 20 min sedation | Same day |
| High-resolution manometry (HRM) | £500–£900 | 30 min | Report 3–5 days |
| Timed barium swallow | £300–£500 | 20 min | Report same day |
| Upper GI consultation | £250–£450 | 30–45 min | Same visit |
Prices vary by hospital, by which surgeon or endoscopist does the case, by length of stay, and by whether pre-operative manometry and imaging are already in hand. We come back with a firm quote within one working day.
The problem
The right surgeon, the right subtype-matched procedure.
Achalasia is rare — most gastroenterologists see only a handful of cases a year, and getting the choice between Heller, POEM and dilatation right depends on the manometry subtype. That is what we sort before you commit.
-
Not sure of the diagnosis?
If manometry has not been done, we arrange it — pseudo-achalasia from a hidden tumour has to be ruled out first.
-
Heller or POEM?
Chicago type III (spastic) usually favours POEM. Types I and II do well with either — we match to your case.
-
Want it done properly?
A named consultant upper GI surgeon, intraoperative endoscopy on every Heller, and a post-op contrast swallow before you eat.
The journey
From enquiry to recovery — what happens, in order.
One clinician from first message to review — including the recovery window and follow-up barium swallow.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A day or two in hospital
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Symptoms — dysphagia to solids and liquids, regurgitation, chest pain, weight loss — and any manometry or barium swallow you already have.
- 02
Before
We come back with a recommendation
Within one working day: the right procedure for your Chicago Classification subtype, the right surgeon or endoscopist, and an indicative price. If further testing is needed first, we say so.
- 03
Before
We arrange the appointment
Usually within one to two weeks for consultation, two to four weeks to surgery. Blood-thinning medication is reviewed with the team and you are told exactly how to prepare.
- 04
On the day
Arrival at the hospital
Admission, consent and a chat with the surgeon and anaesthetist. General anaesthetic, clear liquids only for 24–48 hours beforehand to empty the oesophagus.
- 05
On the day
The procedure itself
90 to 180 minutes in a proper theatre. Five laparoscopic ports for Heller (or per-oral endoscopic access for POEM), intraoperative endoscopy to confirm mucosal integrity.
- 06
On the day
Overnight stay
A one to two night stay. A contrast swallow the next morning to confirm no leak before starting liquids.
- 07
After
Recovery and review
Liquid diet 1–2 weeks, soft 2–4 weeks, normal texture 4–6 weeks. Office work in 1–2 weeks, no heavy lifting for 6 weeks. A review at 6–8 weeks with a repeat barium swallow.
Typical end-to-end: 2–4 weeks from enquiry to procedure. Full recovery: 4–6 weeks.
When it helps
When laparoscopic achalasia surgery is the right step.
The symptoms and diagnostic findings we see most, plus the one red flag that means urgent endoscopy — not a booking.
-
Dysphagia to solids AND liquids
Difficulty swallowing both solids and liquids from the start — the hallmark that distinguishes achalasia from a mechanical stricture.
-
Regurgitation of undigested food
Bringing back food eaten hours earlier, often at night — a sign the oesophagus is not emptying.
-
Chest pain, especially type III
Spastic-type achalasia (Chicago type III) causes chest pain that mimics cardiac disease — POEM is often the preferred option.
-
Unintentional weight loss
Weight loss because eating is slow, painful or provokes regurgitation — a marker of disease severity.
-
Bird’s-beak on barium swallow
The classic tapered lower oesophagus with a dilated body — a strong pointer to achalasia, confirmed by manometry.
-
HRM-confirmed types I, II or III
Chicago Classification v3.0 defines the subtype — it drives whether Heller, POEM or balloon dilatation is best.
-
Failed pneumatic dilatation
Recurrent symptoms after one or two balloon dilatations usually mean it is time for definitive myotomy.
-
Red flag: sudden weight loss + age >55
Rapid-onset dysphagia and weight loss over 55 needs urgent endoscopy to rule out pseudo-achalasia from tumour before any dilatation or myotomy.
Treatment options
Heller myotomy is not the only option.
What each option on the table actually involves — and which fits which subtype.
-
Laparoscopic Heller myotomy + Dor
The workhorse for types I and II. Longitudinal myotomy 6 cm up the oesophagus and 2–3 cm onto the stomach, with an anterior partial fundoplication to control reflux. 85–90% symptom-free at 5–10 years.
-
Heller + Toupet posterior fundoplication
An alternative partial wrap (270° posterior) — some surgeons prefer it for reflux control. Nissen 360° is avoided after Heller due to obstruction risk.
-
POEM (per-oral endoscopic myotomy)
A tunnelled endoscopic myotomy with no external incisions. Particularly good for type III (spastic) because the myotomy can be extended through the spastic segment. Limited to specialist UK centres.
-
Pneumatic balloon dilatation
Outpatient endoscopic stretching of the lower oesophageal sphincter. Effective for types I and II; multiple sessions may be needed and perforation risk is 2–6%. Less used in the UK since POEM.
-
Botulinum toxin injection (EGD)
A temporary option — injected into the lower oesophageal sphincter at endoscopy. Effect wears off over 6–12 months. Best for very frail patients unfit for definitive treatment.
-
Oesophagectomy
Last-resort surgery for end-stage megaoesophagus (sigmoid oesophagus) after failed myotomy and dilatation. Rarely needed if achalasia is treated early.
-
Redo myotomy
For symptom recurrence after Heller or POEM. Usually performed in the opposite plane — laparoscopic Heller after POEM, or POEM after Heller — at a specialist centre.
-
Consultation only
An honest discussion of manometry, subtype and options — no obligation to proceed with any procedure.
Our vetted UK network
A small panel of upper GI surgeons, we picked them.
Consultant upper GI surgeons and POEM-trained gastroenterologists in London, Manchester, Newcastle and beyond. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every surgeon in our network.
-
Consultant upper GI surgeons or interventional gastroenterologists, not trainees or general clinicians
-
High-volume achalasia practice — Heller, POEM and dilatation all offered under one roof
-
Intraoperative endoscopy on every Heller myotomy to confirm mucosal integrity
-
Manometry and barium swallow reviewed personally before booking any procedure
Safety and recovery
What to expect afterwards — honestly.
Laparoscopic Heller and POEM are safe in experienced hands. The things worth planning are subtype-matched choice, the graded diet, and knowing what is normal after.
-
General anaesthetic in a proper theatre
Both laparoscopic Heller and POEM need GA. A pre-op assessment covers fitness, medications and any prior abdominal surgery.
-
Mucosal perforation is the main intra-op risk
Around 5–10% of Heller myotomies have a small mucosal injury during the procedure. Recognised and repaired at the time, it does not affect long-term outcome.
-
Reflux after myotomy is common
Around 30–40% get reflux after Heller without a wrap, 10–20% with a Dor. POEM (no fundoplication) has 40–60% reflux — long-term PPI is often needed.
-
A contrast swallow before eating
A water-soluble contrast swallow the next morning confirms no leak before liquids are started. Standard for both Heller and POEM.
-
Diet progresses in stages
Clear liquids for the first 24 hours, full liquids 1–2 weeks, soft diet 2–4 weeks, normal texture 4–6 weeks. Rushing the progression risks disruption.
-
Persistent dysphagia in 5–15%
A minority still struggle to swallow after myotomy — usually from an incomplete myotomy or scarring. Balloon dilatation or a redo procedure can help.
-
Rare but serious complications
Pneumothorax, splenic injury, bleeding, DVT/PE and (rarely) mediastinitis after POEM. All uncommon in experienced centres.
-
Long-term surveillance
Even after successful treatment, achalasia carries a small long-term risk of oesophageal cancer — periodic endoscopic surveillance is discussed.
-
Red flags
Fever, chest or abdominal pain out of proportion, shortness of breath or vomiting blood after surgery are not normal — call the team or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the surgeon or endoscopist sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis and subtype
Achalasia confirmed on HRM with Chicago Classification subtype (I classic, II panoesophageal pressurisation, III spastic), and any imaging findings such as bird’s-beak.
- 02 Technique
Procedure performed
Whether laparoscopic Heller with Dor or Toupet, POEM (with tunnel length and orientation), or pneumatic dilatation with balloon size and pressures.
- 03 Findings
Myotomy length, mucosal integrity, wrap
Total myotomy length (typically 7–8 cm), intraoperative endoscopy findings, any mucosal injury and repair, and the fundoplication constructed.
- 04 Impression
Recovery, diet stages, reflux plan
Read this first: diet progression, when to restart normal activity, whether PPI is recommended, and follow-up timing for barium swallow.
Recognised by major UK insurers
Cover for achalasia surgery is standard on most UK PMI policies with a valid GP or consultant referral. POEM cover varies — we confirm cover and pre-authorisation before booking.
Frequently asked
Everything we get asked about achalasia surgery.
Quick answers on diagnosis, Heller versus POEM, cost, reflux and long-term results.
-
What is achalasia and how is it diagnosed?
Achalasia is a rare motility disorder where the lower oesophageal sphincter fails to relax and the oesophageal body loses peristalsis. Diagnosis needs high-resolution manometry (HRM) — the gold standard, subtyped by Chicago Classification v3.0 into type I (classic), type II (panoesophageal pressurisation) and type III (spastic). Endoscopy rules out a tumour mimicking achalasia (pseudo-achalasia), and a timed barium swallow shows the classic tapered "bird’s-beak" appearance and measures how well the oesophagus empties.
-
Heller myotomy or POEM — which is better?
For types I and II, laparoscopic Heller with an anterior partial (Dor) fundoplication and POEM give comparable symptom control (85–90% at 5 years). Heller has less reflux because of the wrap. For type III (spastic) POEM is generally preferred because the myotomy can be extended along the spastic oesophageal segment, which is not practical with Heller. Choice also depends on prior surgery, body habitus and the availability of a POEM-trained centre.
-
How much does laparoscopic Heller cost privately in the UK?
Roughly £8,000–£14,000 for laparoscopic Heller with Dor fundoplication, including hospital, surgeon, anaesthetist and one to two nights’ stay. POEM is £6,000–£10,000 in the small number of UK centres offering it. Balloon dilatation is £400–£800 per session. We confirm firm figures within one working day.
-
What is the recovery like after Heller myotomy?
One to two nights in hospital, a contrast swallow the next morning, then clear liquids. Full liquids for 1–2 weeks, soft diet 2–4 weeks, normal texture at 4–6 weeks. Office work in 1–2 weeks, driving in 1–2 weeks, no heavy lifting or strenuous exercise for 6 weeks. A follow-up appointment at 6–8 weeks with a repeat barium swallow.
-
Will I get reflux after achalasia surgery?
Some reflux is common — the myotomy weakens the anti-reflux valve. Heller with a Dor wrap gives 10–20% reflux, Heller without a wrap 30–40%, and POEM (no wrap possible) 40–60%. Long-term PPI is often needed after POEM. The Dor is preferred over Nissen 360° because a full wrap can cause obstruction after myotomy.
-
Can pneumatic dilatation be used instead of surgery?
Yes, for types I and II. It is done at endoscopy under sedation using a graded balloon (30, 35, 40 mm). Success is 60–80% at 5 years but many patients need repeat sessions, and perforation risk is 2–6%. UK use has fallen since POEM became available, but it is still a valid option, particularly for older patients or those who want a non-surgical route first.
-
How successful is laparoscopic Heller myotomy long term?
In experienced hands, 85–90% of patients are symptom-free or much improved at 5 years, and 80–85% at 10 years. Persistent or recurrent dysphagia occurs in 5–15% — usually from an incomplete myotomy or scarring, and often treatable with balloon dilatation or a POEM as a second-line procedure.
-
When should I see a specialist urgently?
Sudden onset dysphagia and weight loss over the age of 55 needs urgent endoscopy to rule out oesophageal cancer masquerading as achalasia (pseudo-achalasia). Vomiting blood, severe chest pain after any dilatation or myotomy, fever or shortness of breath after surgery are all reasons to seek same-day medical help.
Related treatments
Looking for something else?
Nearby in the library