Khashab MA, Sanaei O, Rivory J, et al. - In this single-blinded, randomized, noninferiority international clinical trial, researchers compared the effectiveness of the anterior and posterior approaches at 1 year after peroral endoscopic myotomy (POEM). Adult patients with a confirmed diagnosis of achalasia via high-resolution esophageal manometry were eligible candidates. For this investigation, 150 patients were randomized to receive either anterior (n = 73) or posterior (n = 77) POEM. One hundred forty-eight individuals received the POEM treatment, and 138 patients completed the 1-year follow-up and were involved in the primary efficacy analysis. In 90% of patients in the anterior group and 89% of patients in the posterior group, clinical success was achieved. In terms of efficacy and safety in treating patients with achalasia, posterior myotomy during POEM was not inferior to anterior myotomy.