For achalasia: which is better: dilation or myotomy?

Myotomy: With the ability to perform a myotomy laparoscopically, there is really no question that if you are healthy enough to have surgery then a myotomy is the way to go. Dilations and Botox injections work for a while, but need to be repeated. Whereas with surgery very rarely will a repeat operation be required.

Myotomy: It has higher success rates (~90%) and is longer lasting.

Usually myotomy: Very patient has different goals an tolerance or procedures. Dilation usually requires at least two sessions, and is 85% effective at 5 years, and myotomy is 90-95% effective at 5 years after a single treatment, but is more invasive. There is a new way to do myotomy called per oral endoscopic myotomy (poem). This method is being done in san diego, portland, chicago, cleveland, and springfield, ma.