Achalasia is a rare esophageal motility disorder in which endoscopic pneumatic dilation (PD) is a commonly used therapeutic option. This study aims to evaluate the effectiveness of PD in symptomatic improvement using the Eckardt score, to identify factors associated with multiple PD sessions, the interval between PDs, and the occurrence of complications.

Single-center, retrospective study including patients diagnosed with achalasia who underwent PD between January 2005 and October 2025. Patients without follow-up or with less than 2 years of follow-up after PD were excluded. Demographic, clinical, procedural, and symptomatic evolution data were collected based on electronic medical records and, when these were unavailable, through follow-up phone calls. Statistical analysis were performed using SPSS software version 30, with a p-value of <0.05 considered statistically significant.

A total of 51 patients were included, 53.8% (n=28) female. Type I achalasia was the most frequent (65.0%, n=13). A total of 83 PD were performed, with a mean of 1.63 PD needed per patient. The 35mm dilation ballon was used in 12 patients (18 PD (21.7%)). The mean age at symptom onset was 50.35 years [21-78], and the median interval from symptom onset to PD was 2 years [0-19]. Median follow-up was 116.27 months [26.13-253.10]. The median interval between dilations was 25.7 months [2.33-227.70], with no significant associations with the Eckardt score. Adjusting for patients requiring multiple dilations (n=22; 43.1%), they had no improvement of the Eckardt dysphagia subscore (p=0.014), smaller interval between symptom onset and PD (p<0.001), and greater maximum balloon diameter used (35mm in 12 patients (48.0%)) (p<0.001). One perforation occured, in the third PD of a female patient (the first with 35mm dilation ballon) successfully resolved after 7 days of treatment with VacStent GI™.

Pneumatic dilation showed high effectiveness in improving symptoms in achalasia, with sustained benefit over long-term follow-up. The need for multiple dilations was mainly associated with symptomatic recurrence. These findings support PD as a safe and effective therapeutic option, emphasizing the need for individualized follow-up and identification of patients who may benefit from alternative therapies.