Current treatment options for achalasia include endoscopic pneumatic dilation and surgical laparoscopic Heller’s myotomy (LHM). A multicentre, randomized trial compared LHM plus Dor’s fundoplication with the less-invasive peroral endoscopic myotomy (POEM) in patients with idiopathic achalasia. The primary endpoint of clinical success at the 2-year follow-up was observed in 83.0% of the 112 patients undergoing POEM and 81.7% of the 109 patients undergoing LHM plus Dor’s fundoplication. Thus, POEM was non-inferior to LHM plus Dor’s fundoplication (P = 0.007 for non-inferiority). 44% of patients who underwent POEM and 29% of patients who underwent LHM plus Dor’s fundoplication had reflux oesophagitis at the 2-year follow-up.