This method is different from the laparoscopic Heller procedure in that the periesophageal muscle is incised under direct vision along the interstitial layer (submucosa) of the esophagus after the superficial (mucosal) “window” is opened, and the superficial fissure is closed with a metal clip. The procedure of transoral endoscopic myotomy (POEM): 1) anesthesia: the patient is placed under general anesthesia with tracheal intubation. 2) esophageal mucosal layer incision: 8-10 cm above the gastroesophageal junction (GEJ), a submucosal injection is performed in the right posterior wall of the esophagus. The submucosal layer was revealed by a longitudinal incision of about 2 cm with a Hook knife. 3) Separation of the submucosal layer: The submucosal layer was separated from top to bottom along the esophagus with a Hook knife, and the submucosal injection was performed while separating. The submucosal layer was separated to avoid breakage and perforation of the mucosal layer, especially in the fundus area. 4) Circumferential muscle incision: Under direct gastroscopy, the circumferential muscle was incised longitudinally from the top to 2 cm below the GEJ using a TT knife from 7-8 cm above the GEJ. 5) Metal clips were used to close the incision in the mucosal layer. This shows that this method has some limitations and some surgical complications, such as esophageal or gastric perforation and postoperative recurrence. Because the esophageal wall is thick due to long-term inflammation in cardia patients, and the adhesions with the surrounding tissues are heavy, POEM is prone to bleeding and suturing difficulties, and in some patients the surgery takes 12 hours (we have been approached by some patients), but the expected surgical results are not achieved, and another surgical treatment is needed. The use of minimally invasive POEM treatment can provide short-term relief of dysphagia in patients with achalasia (AC), but the long-term outcome and its long-term complications are still subject to further follow-up. Currently, our department has treated 8 patients with unsatisfactory results after POEM. In particular, POEM is less effective in patients with longer duration of cardia failure, severe esophageal dilatation and esophageal deformation. The advantage of thoracoscopic or laparoscopic lower esophageal and cardia myotomy for cardia loss is that the lower esophageal and cardia myotomy are more adequately incised and stripped, and the postoperative results are good, and if a partial fundoplication is attached, the chance of reflux after surgery is small. Surgical lumpectomy is a mature technique and the operation time is also very short, usually 0.5-1 hour. Intraoperatively, we usually cooperate with gastroscopy, which can play two roles: first, intraoperative gastroscopy can help surgeons understand whether the extent of incision of the muscular layer meets the requirements; second, after incision of the lower esophagus and cardia muscular layer can be clarified by intraoperative gastroscopy whether there is mucosal damage, and if there is mucosal damage can be repaired under lumpectomy, avoiding the occurrence of esophageal or gastric perforation. Each method has its advantages and disadvantages, therefore, we need to look at the technology of transoral endoscopic myotomy (POEM) for pancreatic atelectasis correctly, not to blindly pursue it, exaggerate it, overemphasize the advantages of this technology and avoid talking about its limitations. Science is rigorous, be realistic!