Pneumatic dilation in achalasia

Pneumatic dilation is the most common first-line therapy for the treatment of achalasia. The aim of dilation is a controlled disruption of circular mu scle fibres of the lower esophageal sphincter to reduce the functional obst ruction. Several types of dilators and different dilation techniques are us ed, but the achieved results are similar. The mean success rate is about 80 % in the short term, but some patients need redilation in the further cours e (particularly young patients). Best long term results are obtained if the lower esophageal sphincter pressure can be reduced below 10 mmHg. Major co mplications are rare after pneumatic dilation; the most serious complicatio n is esophageal perforation, which occurs at a mean rate of about 2.5%. Con sidering the pros and cons of other effective forms of treatment of achalas ia (esophagomyotomy and intrasphincteric injection of botulinum toxin), pne umatic dilation is still the treatment of choice in the majority of patient s with achalasia.