The patient is an 18 year old who had been treated for GERD for several years. His symptoms were worsening and he had suffered a 50lb. weight loss. He presented to us for a second opinion and a presumptive diagnosis of achalasia was made. Manometry showed a peristalsis and a hypertensive LES. Esophagram showed a classic bird's beak deformity. After presenting treatment options, the patient and a family elected to proceed with Heller myotomy. The patient is in modified lithotomy position and a standard 5 trocar technique is used. The endoscopist places an 18mm, 8cm esophageal dilatation balloon bridging the GE junction. The longitudinal fibers are disrupted and due to the balloon the circular fibers are easily seen and safely disrupted with minimal use of cautery. The myotomy is assessed for completeness and for mucosal integrity using the video. The muscle bundles are sutured to the respective crura to keep the myotomy open. The patient was fed and discharged on pos-op day one. He returned to the clinic 3 weeks later with a 30lb. weight gain.