POEM or Heller Myotomy? What are the pros and cons?

Posted , 24 users are following.

Hi all,

I decided to have the Heller Myotomy and got sheduled to have it on Wednesday.  The reason I chose this over POEM was due to the fact the POEM is a new procedure, and there are no long term studies on it.  

I talked to the POEM surgeon on the phone yesterday, and what I heard him say (note - I might heard wrong) is that POEM is more effective in reducing my esophageal spasms than Heller Myotomy.  

I am confused on what I should do.  I am collecting pros and cons for each procedure to determine which one would be the best choice for me.  

Any input is greatly appreciated!  Please note, I have type 2 Achalasia, and I am looking for a treatment for my esophageal spasms. 

Thank you,



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  • Posted

    Hi Sonia.  I can't believe this but I think we know each other.  (I thought it was a coincidence that your name was Sonia) I could be wrong but if you live in Berkeley then I think I'm right.  Are you the Sonia who knows Stephanie?  If you are, it's me, Amy, her friend who you've met a few times.  We seem to have the exact same kind of Achalasia.  I haven't talked to anyone else who has had the esophageal spasms for years and then been diagnosed with type 2 Achalasia.  We should definitely keep in touch around this!  Amy
  • Posted

    hi, i have stage 2 achalasia. i was first diagnose about 15 years ago and i was able to live with the symptoms until early 2013, most gi doctors dismissed my illness as gerd until i could no longer, eat or sleep, was loosing excessive weight.i tried herbs, acupunture, chiropratic care, had 6 endoscopies, 2 barium swallow and 2 swallow test, i felt like there was no help for me. i did the poem in october 2013. i was about the 104th case for my doctor. best decision i ever made. i know its not a cure, but i can eat, swallow, sleep, be out in public without always throwing up. i take protonics twice a day, but a change in diet, really helped. each person situation is different, i hope you find the one that will work for you.
    • Posted

      Thanks for sharing your story with me Wendy.  Did you have esophageal spasms (that did not occur during eating) prior to the surgery?  And, if so, did they go away?   Also, what is protonics?  Thank you!  Amy
    • Posted

      hi Amy, i had the spasm before the surgery. they have since gone away. the protonics are for acid reflux, which i have as a result of the spincter muscles being cut to allow the food to pass into the stomach. there are days when i dont need them, but given even with monitoring my diet, i eat a lot of spice. i hope this help. i have some follow up test to do in may to see how well my poem was, as i also signed up to be part of the research study, as poem is still new. i would love to find someone who has had the procedure 5 years or more to see how they progress is.
    • Posted

      Thanks Wendy.  Good luck with your follow up test!   Amy
  • Posted

    Hello Sonia,

    I live in Rhode Island, USA, I am 29 and I also have type 2 achalasia. I am at the point where I need to choose between the Heller procedure or the POEM. I see the benefits of both and was told I was the perfect canidate for either procedure. The tricky part is potentially setting myself up with life long heartburn, I would just be replacing one issue with another, and I am concerned with future issues with the POEM because it is so new (How will I be when Im 60, ya know?). I will be having my procedure in Boston, MA. as soon as I can make this choice.

    I am currently squeezing a 10mg Niphedipine tablet under my tongue 30 mins before each meal up to three times a day just to eat, so the choice needs to be made soon before I build up a tolerance for the drug.

    How do you feel now that u did it? Any spasms? I saw that u mentioned u felt like maybe u should have tried the POEM due to the soreness u feel now. I am so torn and I thought I would do the POEM to save on scarring and recovery time, knowing I can always go back and to the dor fundop. later if needed.

    I wish I knew what caused this. I had part of my thyroid removed in 2009 and have had the spasms ever since. I was told the procedures may not stop my spasms and those are worse than barfing up everything I eat and drink. Feels like a crippling heart attack...yuck.

    I thought I would be having kids by now in life, but instead I am struggling to stay above 100 pounds and being forced to choose between a new less invasive procedure that doesnt have much long term info, or a sure fire way to feel better but ill have the scars to remind me of how Im suffering.

    I am sincerely glad that u are on ur way to normalcy. I know this choice is mine alone in the end, but if u or anyone out there has any insight in what I should do or how I can make a good choice here, dont be shy help a sister out.

    All my best,


    P.s. eat a cheeseburger for me....mmm

  • Posted

    Hey Sonia,

          I had POEM surgery around June 2013 and its been more than 2 and half years. The surgery was done well and I am sure i could say that my swallowing was so much better after the surgery. I have gained a lot of weight since my lowest. But I have put on fat on my stomach as well and I feel that will impact the swallowing function for achalasia. Even now I can swallow food. But I feel the swallowing functionc an be improved well if certain things are followed. But I would definitely recommend you speaking with the doctors which is best for you.

    Here I give you some tips and advices. Any queries, feel free to ask.

    Make sure you exercise regularly. Have an active life now and then. Why I say this is that, when you exercise well your appetite will improve and I have experience that your swallowing would function more better when you have good appetite to eat. make sure you split your meals well. 5 meals a day with a gap of 3 hours in between will be fine. You can have smaller quantity every meal. 

    And don't do anything while eating. Like watching tv or doing something while eating. Don't have any conversations while eating either. Instead focus on what you eat. Relish every bite you take. Chew well and swallow well before taking another bite. What most achalasia people tend to do is they try to take the food and just push it down by taking another bite. Don't do that. Instead have your consious on eating alone and chew your food, relish it and swallow well. Seperate yourself so you can focus on what you eat.

    Make sure you eat more calories than you burn a day. Don't try to eat heavily when you have appetite. When you feel you had sufficient amount of food that would be well enough. Instead of going on and eating because you love the food. Try to avoid that. 

    Make sure you have a calm life. Just be calm and be active. Love yourself. Everyone is unique in their own way. Make sure you love every bit of yourself well. 

    Good luck Sonia! 

  • Posted


      I had a Heller Myotomy with a Dor Fundoplication about seven years ago. That is when they found out I was already in end stage Achalasia. I was 54 at the time. I was very happy with the outcome, other than having more reflux, but still no aspiration. I have never had spasms as far as I know so I may not speak of them.

       In Sept. 2015 I had POEM Surgery recommended by my Doctor who did the original operation and he said it would resolve my swallowing problems, which had started up again.

       I wished I had never had the POEM Surgery. Food sticks worse than ever, I have terrible reflux and now I am aspirating it into my lungs when I sleep at night. I have had one dilation since the POEM Surgery which did not help with the swallowing and crreated more reflux. I believe these operations to be a balancing act of opening the LES enough to swallow, but not so much as to allow to much reflux to go through the other way. I would go with the Heller Myotomy and Dor Fundo. I also had a pyloromyotomy to help my stomach pass food through to my small intestine at a daster rate, because I had several blockages and was hospitalized the last time with a blockage that took four days to correct. The Pyloromyotomy has worked correctly.


  • Posted

    Hi everyone. Thanks for all the info on this site; it's very helpful. Just knowing that you have all been through this is helpful! My name is Lisa and I too am trying to decide between the POEM and Heller Myotomy. I'm in San Francisco and just saw my GI at Kaiser in South SF for the first time since diagnosis one month ago with symptoms for nine months. I was hoping to get a referral to Stanford for a consutlation to discuss POEM and get Kaiser to pay for it but it turns out that Kaiser is now offering POEM so that won't work. The Kaiser surgeon has only performend POEM once or twice, so I don't want him operating on me.

    My GI doc recommends the Heller as a tried and true method that has good outcomes with the Kaiser team. He also thinks the fundo is necessary to lower the chances of GERD although he did say thay many patients develop GERD anyway. He thinks that the the surgeons' experience is the most improtant factor in some ways. Stanford says I can't get in for a consultation unless I have a doctor refer me in and send my records, and I can't wait until open enrollment in January to switch insurances. I'm trying to decide if I should pay for a POEM consult at Stanford or Winthrop in NY where they've done the most in the U.S. or just do the Heller in part to stop stressing and worrying about it.

    I know there's no right answer and every experience is different but if anyone who has had either surgery can offer further insights about their experience and/or outcomes, I appreciate it. I do have spasms at night if my stomach is empty but not otherwise. 

    I would also love to talk to someone who has gone through this so if anyone is local and would like to meet up, please let me know.


    • Posted

      Hi Lisa.  I live in Berkeley.  I had Kaiser and left because I wanted more choices of surgery.  I was lucky to have mild symptoms which has bought me time.  I now have a different insurance company and still haven't decided which surgery to get and with whom.  But one thing I have learned from the surgeons I've talked to is how important experience is with these surgeries. If Kaiser won't pay for the POEM with sugeons outside of Kaiser, I'm not sure what benefit you'll get from going to consultations with them.  How many Heller's has the Kaiser surgeon performed?  Remember that there are different Kaiser locations that would have more surgeons to choose from.  I wonder if the surgeon they're referring you to is Dr. Svahn in Oakland.  I met with him and he seemed very nice and I heard he was a good surgeon.  A year ago he told me that he'd done around 50 Hellers (with wrap).  When it comes to reflux, there is a risk of this with either surgery, though there seems to be a somewhat higher incidence with POEM.  Since I'm still in the process of figuring out what I'm going to do as well, I can't share experiences with surgery.   However, I am interested in meeting with local people to share resoures and information, especially regarding things in the area.  I have reached out and met up with two other women in the area. One in particular and I are interested in forming a local meetup or support group for people with Achalasia in the bay area.  Please let me know if you're interested in meeting with us.  The other woman (I've met with her twice) had the POEM surgery at Stanford.  I've met with a few Heller and POEM surgeons and have been doing research for the past year.  I'd be happy to share what I've learned with you as well as some great resources.  So just let me know and best wishes to you as you figure things out and get what you need!  Amy
    • Posted

      Hi Amy.

      Thank you so much for the reply. I would love to meet with you and the other women or talk on the phone. I'm available tomorrow between 1:30 and 5:00 p.m. or this Saturday night or Sunday all day. My GI agrees with you that expereince is the most important factor, and they do lots of Heller's with fundo at SSF. If I do POEM, I'll have to pay out of pocket. I am very interested in GERD issues for patients who have had the HM or POEM. I am also very interested in hearing about your resouces and conversations with surgeons and the woman you spoke to who had POEM at Stanford. I really appreciate your response and offer of resources and meeting up. It's so nice to be in contact with someone else who has achalasia! 

      Emis Moderator comment: If users wish to exchange contact details please use the Private Message service.


    • Posted

      Hi Amy, I live in El Cerrito and have Kaiser and I'm trying to find the right doctor for a year now. By now it is so bad that I have to have it done. I had a Heller Myotomy 17 years ago with Kaiser and now rather wanted the POEM but can't convince Kaiser. Are you guys still meeting? I would love to hear and share experinces. 

    • Posted

      Hi Amy,

      I live in Concord. I just saw your post from 10 months ago where you mentioned getting a Bay Area meet up together. I'm wondering if you had any sucess in doing that or if you are getting together with any people  with  Achalasia that live in the East Bay? I would be very interested in being part of a group like that. I was diagnosed in January 2017 and have lots of questions. 

      Thank you, I hope to hear from you


    • Posted

      Hi Debby. I'm Lisa and just got a message about your post. Amy and I meet up with two other women a few times in the East Bay and talked to a few others. Amy started a Facebook group called the Achalasia Warriors of the San Francisco/Bay Area you should join. We meet every theee months and our next meeting is May 21st. There are a bunch of informative and helpful FB Achalasia groups. We've all been where you are now. It is hard, scary and isolating. Feel free to ask any questions or if you'd like to talk, let me know and I'll message you my number. I'm sure Amy will respond too but I saw your message and remember posting and waiting for a reply so wanted to make sure you got one.

    • Posted

      Hi Lisa, Amy, et. al.,

      Glad to have found this thread. I was recently diagnosed with type II Achalasia and, like everyone else here, I’m trying to decide between the traditional Heller Myotomy and POEM. Aside from my achalasia symptoms, I’m otherwise young and healthy (in my 30’s), so I'm a good candidate for either procedure. 

      Like many of you, I have Kaiser insurance, which is strongly incentivizing me to go the LHM route. Dr. Svahn, the LHM surgeon at Kaiser in Oakland, seems experienced and competent. He has done the procedure over 100 times with few complications. Conversely, if I go the POEM route, I’d need to do the legwork to find an experienced surgeon myself, and probably end up paying out of pocket.  

      I’ve read this thread, and various papers in the academic literature, so I feel like I have a good understanding of the pros and cons of POEM, but this hasn’t made my decision any easier.  

      I’d love to talk to anyone in the Bay Area who has gone through this. Any suggestions for local POEM surgeons I should consult with? And any advice for navigating the Kaiser system if I go that route? I get the feeling it’s a lost cause, since Kaiser isn’t very amenable to going outside their walls. 

      Unfortunately, it looks like I just missed your gathering in May, but I’d be happy to meet in person any time. I will also join the Facebook group, but probably using an alternate account from my main FB account, since I’m not quite ready to broadcast my condition to all of my friends (and FB doesn’t seem to provide a way to turn that off unless the group is “secret"wink

      I hope you're all doing well, considering,


    • Posted

      Hi Kevin. I just sent you a private message iwht my contact info. I'm happy to chat or answer questions. 


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