Pneumatic dilatation as the primary treatment for achalasia.

Pneumatic dilatation under fluoroscopic control has proven highly successful in the treatment of achalasia. This procedure involves minimal morbidity, local anesthesia is employed, and hospitalization is brief, usually only two days. Surgical myotomy of the lower esophageal sphincter, the Heller procedure, requires a thoracotomy under general anesthesia with its attendant morbidity and at least ten days of hospitalization. In addition, there is a significant incidence of postoperative gastric reflux. We have employed pneumatic dilatation as the sole primary treatment for 30 patients over the last 10 years. The results have been highly successful with marked relief of symptoms and weight gain. Pneumatic dilatation is an effective treatment for achalasia and is recommended as the initial procedure of choice.