• The primary outcome of the study is the incidence of significant reflux esophagitis (≥grade B) in cases with standard and extended gastric myotomies at 6 months after POEM~Secondary outcomes:~Significant esophageal acid exposure (>6%) as defined by the revised Lyon consensus~Symptoms of GERD (GERD HRQL)~Clinical efficacy (Eckardt score≤3)~Esophageal emptying at 5 minutes~High resolution manometry parameters (LES pressures and Integrated relaxation pressure in mmhg units)~All the secondary outcomes will be assessed at 6 months after poem procedure~Eligibility:~Eligible cases with idiopathic achalasia (type I and II) will be enrolled in the study and randomized (1:1 ratio) in two groups according to the length of gastric myotomies~INCLUSION CRITERIA :~Idiopathic achalasia (type I and II)~Age ≥18 years~Willing to provide informed consent and comply with the study protocol~Exclusion criteria~Ineligibility for POEM procedure~Spastic esophageal motility disorders~Presence of esophageal diverticulum and hiatal hernia~Prior hellers myotomy with or with out fundoplication
This observational study will be conducted among 43 patients of both sexes in each group Study participants will be of the age more than 18 years~STUDY PROCEDURE-Pre-defined technique to avoid bias and confounding due to multiple factors~All the poem procedures will be performed by posterior route~Preservation of sling fibers will be attempted in all the cases to avoid heterogeneity~Length of esophageal myotomy will be kept constant (4-6cm)~Double scope technique will be utilized to confirm the gastric extent of myotomy~First evaluation at 1-month: based on Symptoms~• Second evaluation: at 6 months by~Objective evaluation: UGI endoscopy, High resolution manometry, Timed barium swallow~Eckardt score, GERD-HRQL~24-hour pH study with manual readings