Management of achalasia of the cardia by forced pneumatic dilatation.

Eighteen patients with achalasia of the cardia diagnosed by radiography, endoscopy, and manometry were subjected to forced pneumatic dilatation under fluoroscopic control. The procedure was uneventful in all but one patient who developed a pneumomediastinum which resolved on conservative management. A satisfactory result was obtained in 16 patients (89%), 10 patients remaining asymptomatic and six patients having mild symptoms only in follow-up periods of up to 10 years. Only two patients have unsatisfactory results, one having developed a peptic stricture and one having a fibrosed incompetent lower oesophageal stricture with moderate reflux. The success rate of forced dilatation is similar to that of cardiomyotomy but, as it is a relatively minor procedure with a low incidence of complications and a short hospital stay, we conclude that there is an important place for forced pneumatic dilatation in the first line management of achalasia of the cardia.