Achalasia is a complex, debilitating, and incurable disease. Several treatment modalities exist for palliation of symptoms. Up to 25% of patients will require reintervention yet no gold standard treatment for reintervention has emerged. Cumulative experience suggests reoperative Heller esophagomyotomy (HM) is a safe and viable option after previous myotomy or pneumatic dilation. Peroral endoscopic myotomy (POEM) has shown promising results for index treatment and reintervention. Single center studies suggest HM after POEM carries a lower success rate and should be chosen in select situations. Disease progression, sigmoid or megaesophagus favor esophagectomy as a definitive option.
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