Success of conservative treatment of achalasia depends mostly on complete dilation of the cardia and not on drug therapy or dietetic management. Those interested in the conservative treatment of achalasia are in complete agreement that some type of dilation of the cardia is needed to overcome the obstruction, but there is a very wide difference of opinion as to the procedure by which this is to be accomplished. Each of the following methods has its advocates:
(1) Dilation with mercury-filled bougies; (2) dilation with bougies passed through the esophagoscope; (3) dilation with the combined mercury bougie and pneumatic dilator; (4) dilation with a pneumatic or hydrostatic dilator, and (5) dilation under fluoroscopic control.
It is not claimed by the advocates of any of the procedures that the dilated esophagus will return to normal after thorough dilation of the cardia, even though the obstructive symptoms have been completely relieved. As a