Pneumatic dilatation in the treatment of achalasia.

The results of a European survey on pneumatic dilatation in the treatment of achalasia have been compiled from a questionnaire completed by 18 different surgical teams. The total number of patients investigated was 2,161. Surgical treatment was prescribed by 94% of teams, whereas pneumatic dilatation was only prescribed by 56%. The indications for pneumatic dilatation were: inoperability (28%), drug failure (17%), surgical failure (11%). Nine surgeons believe pneumatic dilatation is indicated in all cases (50%), four consider it ineffective and useless (22%), and one expressed no opinion (6%). The arguments in favour of pneumatic dilatation are the fact that the procedure is minor and cost efficient and that it is relatively safe and effective with good long-term results in 75% of cases. Pneumatic dilatation should be used as the initial treatment in achalasia; surgery is only indicated in cases of failure.