POEM or peroral endoscopic myotomy is an alternative to the standard Heller myotomy for treatment for achalasia. The procedure is performed under general anesthesia with the patient supine or lateral. The first step consists of the mucosotomy. This is made 2 cm proximal to the predicted start of the myotomy This is followed by a 3 cm longitudinal mucosotomy at the 3-o'clock position. The second step involves creating the submucosal tunnel. The tunnel is carried down beyond the high pressure zone. There we inject epinephrine to mark the terminal end of the submucosal tunnel. We then remove the scope from the submucosal tunnel and confirm on retroflexed gastric view the blanched mucosa 2-3 cm distal to the GEJ. The third step is the myotomy. This involves performing a selective myotomy of the circular muscle starting 2 cm distal to the mucosal incision. After the myotomy is completed, the scope is withdrawn and easy passage into the stomach is confirmed on several passes. The final step of the operation is closure of the mucosotomy with endoscopic clips. In comparison with surgical myotomy, a recent meta-analysis found that POEM was more effective than a laparoscopic heller myotomy in relieving dysphagia although it was found to be associated with a higher incidence of pathologic reflux. In conclusion, in the hands of a trained operator, POEM can be a viable alternative to a traditional Heller myotomy for the treatment of achalasia.