Achalasia is a disorder of esophageal motility characterized by absent relaxation of the lower esophageal sphincter and abnormal peristalsis of the esophagus during swallowing. The etiology is divided into primary idiopathic achalasia and secondary achalasia and classified into 3 subtypes based on manometric evaluation, according to the Chicago 4.0 classification. The goal of the therapy is symptomatic improvement and prevention of late complications. While there are several endoscopic therapies, the gold standard therapy is laparoscopic Heller myotomy. Since its debut in 2008, per-oral-endoscopic-myotomy (POEM) became an accepted treatment for achalasia with non-inferior short term outcomes compared to Heller myotomy. In the following review, we will explore the indications, guidelines, and controversies in the modern treatment of achalsia, focusing on the Heller myotomy versus POEM.