Objective To compare the relationship between different myotomy procedures and operation duration, efficacy and complications of peroral endoscopic myotomy (POEM), so as to provide guidance for the selection of operation procedures for the treatment of achalasia with POEM. Methods A retrospective study was conducted involving 70 patients diagnosed achalasia in Peking Union Medical College Hospital from April 2020 to October 2023 who underwent POEM operation. Patients were divided into conventional myotomy group (Group A), Short myotomy group (Group B) and full-thickness myotomy group (Group C) according to length and thickness of myotomy to compare differences in operation duration, procedure-related complications, efficacy and incidence of postoperative reflux esophagitis between Groups A and B, and between Groups A and C. And the differences in the efficacy and complications of different myotomy procedures in patients with different achalasia Chicago classification were also compared. Results The operation duration of Group B was significantly lower than that of Group A, and there were no statistically significant difference in procedure- related complications, efficacy and incidence of postoperative reflux esophagitis. There were no statistically significant differences between Group A and Group C in operation duration, procedure-relatex complications, efficacy, and incidence of postoperative reflux esophagitis.There was no statistically significant differences between conventional myotomy, short myotomy and full-thickness myotomy in patients with type I and type II achalasia in the efficacy and postoperative reflux esophagitis. Conclusion Short myotomy POEM procedure can achieve the same effect compared with Conventionalmyotomy, and the operation duration is shortened, and the complication rate is not increased. Compared with conventional myotomy, full-thickness myotomy has about the same treatment efficacy, operation duration and complication rate.