Despite major endoscopic advances in the treatment of primary achalasia, particularly with peroral endoscopic myotomy (POEM), pneumatic dilation remains an important therapeutic option. Assessing its real-life outcomes in local clinical practice is essential to optimize patient management.

The aim of this study was to evaluate the clinical results of pneumatic dilation in primary achalasia.

Prospective single-center study including patients with confirmed primary achalasia and Eckardt score >3, treated with 30-mm pneumatic balloon dilation between January 2023 and September 2024. Clinical follow-up was performed at 2 weeks, 1, 3, 6, and 12 months. Additional dilation sessions were performed for persistent symptoms (Eckardt score >3). Treatment success was defined as clinical remission (Eckardt score <3) without need for POEM or surgery at one year.

Twenty-eight patients were included (mean age 51 years, range 17–79; M/F = 0.4). Achalasia type: I (n=24), II (n=3), III (n=1). Twelve patients (44%) achieved remission after a single session, 7 (26%) after two sessions, and 8 (30%) after three sessions. At one year, 21 patients (75%) were in clinical remission. One patient required surgery, and two underwent POEM. One esophageal perforation occurred; no other major complications were reported.

In our single-center experience, pneumatic dilation with a 30-mm balloon proved to be an effective and safe method for treating primary achalasia, achieving clinical remission in nearly three-quarters of patients at one year.