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Treatment of achalasia targets the mechanical disruption of the muscle fibers of the lower esophageal sphincter by either pneumatic dilation or surgical myotomy. Many experts advocate use of surgical myotomy (particularly for young men), supported by enthusiasm for laparoscopic surgical intervention and favorable results from single-center studies.
To compare the treatments, researchers randomized 214 patients in Europe with newly diagnosed achalasia to receive either pneumatic dilation or laparoscopic Heller myotomy with a Dor antireflux fundoplication in a prospective, multicenter trial. Initial dilation was conducted with a 35-mm Rigiflex balloon, but the protocol was amended to specify the use of a 30-mm balloon for the first dilation af…