Pneumatic dilatation in oesophageal achalasia. Factors influencing results.

Pneumatic dilatation was performed for oesophageal achalasia in 19 consecutive patients without previous endoscopic or surgical treatment. There were no complications. Relief of symptoms was excellent or good in 11 cases during follow-up averaging 43 months. The outcome was better in patients older than 45 years than in younger patients. More than two repetitions of dilatation did not improve the results. Modified Heller's cardiomyotomy was performed on five patients with poor result after two to six dilatations. Pneumatic dilatation is safe and effective as initial treatment of oesophageal achalasia particularly in older patients, with cardiomyotomy reserved for those who do not respond to two dilatations.