AbstractBackgroundTreatment of achalasia is complicated by symptom recurrence and a significant risk for severe complications. Endoscopic myotomy was developed in the search for a highly efficacious treatment with lower risks. Since its introduction in 2010, several centers have adopted the technique and published excellent short‐term results of open label series. Randomized trials with long‐term endpoint comparing per‐oral endoscopic myotomy (POEM) with the established treatments such as balloon dilation and surgical myotomy are now warranted, before POEM can be regarded as the routine clinical care for achalasia patients.PurposeThis review describes the development, technical aspects, efficacy, and complications of POEM.