Achalasia of the Esophagus: Results of Therapy by Dilation, 1950–1967

The past two decades have seen changing patterns of therapy for achalasia of the esophagus. Availability of esophageal motility studies and cineradiography has made more accurate diagnosis posssible. Whereas, in the past, forceful dilation was the only definitive mode of treatment, the success of esophagomyotomy has resulted in its increasing use. Of 456 patients treated primarily by dilation at the Mayo Clinic from 1950 through 1967, 408 patients had hydrostatic dilation performed one or more times, whereas 48 had simple dilation with sounds. Long-term follow-up data on 77 percent of patients who had forceful dilation revealed that 65 percent had excellent or good results, 16 percent were improved but still had significant symptoms, and 19 percent were not improved. Fifty patients subsequently underwent esophagomyotomy because of unsatisfactory initial results. Of 19 patients with complications, ten required mediastinotomy and surgical repair of instrumental perforations. Although forceful dilation can be used in poor risk patients and those who decline operation, the significant incidence of complications and the frequent need for multiple dilations have made esophagomyotomy the preferred form of initial treatment.