Witzel pneumatic dilation for achalasia: safety and long-term efficacy 
 Forceful dilation of the lower esophageal sphincter is considered primary therapy for achalasia.
 The Witzel pneumatic balloon dilator, unlike fluoroscopically placed dilators, is placed over a standard gastroscope allowing positioning and dilation under direct vision.
 We report our experience with the Witzel dilator in 45 patients with achalasia over a 5-year period.
 All patients had at least one major symptom score of 8 out of 10 for dysphagia and/or regurgitation before dilation.
 After Witzel dilation, symptomatic response was graded as excellent (score 0 to 2), good (score 3 to 5), fair (score 6 to 8), and poor (no improvement).
 Symptom response was assessed after 1 week, 1 month, 6 month, 1 year, and present.
 The mean period of follow-up was 25 months (range, 3 to 85 months).
 Passage of the balloon across the gastroesophageal junction was technically unsuccessful in three patients.
 Esophageal perforation occurred in two patients (4%) and transient chest pain greater than 2 days in three patients (7%).
 There was no bleeding or death.
 Symptomatic long-term improvement was excellent in 25 patients (63%), good in 6 patients (15%), fair in 4 patients (10%), and poor in 5 patients (12%).
 A repeat Witzel dilation was performed in five patients but resulted in good/excellent improvement in only one patient.
 We conclude that pneumatic dilation with the Witzel balloon is a safe, effective procedure for achalasia.
