Pneumatic dilatation in the management of achalasia: experience of 45 cases.

A 15-year experience of the management of achalasia is described. Forty-five patients were managed by pneumatic dilatation after sedation with intravenous diazepam. The mean period of observation was 47.1 months. Eighty-six per cent of patients had either no symptoms or only minor symptoms following the procedure. Perforation occurred in four patients (8.8 per cent) and one of these required surgical intervention. The others were managed conservatively. Four cases (8.8 per cent) developed reflux. One patient died of myocardial infarction. Eighty-four per cent of patients needed one dilatation only and no patient required cardiomyotomy. The method is simple and rapid and most patients were discharged within 24 h of the procedure.