Stavros Stavropoulos, MD, performs per oral endoscopic myotomy for advanced achalasia Sigmoid Type 2. The patient is a 53-year-old man who is a Greek opera singer who is presenting to a Greek operator for treatment of achalasia. Symptoms have been present for 32 years, ASA classification of two, prior treatment: pneumatic dilation with perforation requiring 1-week hospitalization. Eckard score of 6. This video is part of the 11th Annual Long Island Live Endoscopy Course, Frontiers of Endoscopic Surgery.