Reimbursement for endoscopic innovations: the final hurdle

After the introduction of the cardiomyotomy by Dr Ernst Heller in 1913 for treating achalasia, surgeons have pursued a variety of different approaches to performing the procedure: transabdominal, transthoracic, thoracoscopic, and laparoscopic. But from the outset, the essence of the operation has remained the same: a longitudinal division of the lower esophageal sphincter. When the operation evolved to a per-oral endoscopic myotomy (POEM) in 2008, it was regarded as simply another iteration of Dr Heller's operation but by a less invasive route.

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