Haruhiro Inoue, MD, performs a pediatric per oral endoscopic myotomy (POEM) for achalasia. The patient is an 11 year old girl with down syndrome, hashimoto's thyroiditis, sub post repair of complete antriventricular canal (CAVC) defect and doudenal atresia presents for treatment of Achalasia. Durration of symptoms is 116 months. Self inflicted vomiting since 2 years of age. ASA classification II. Regular manometry (2009) complete aperistalsis with incomplete LES relazation and hypertonic LES consistent with classic achalasia.