PURPOSE: To evaluate the clinical effectiveness of fluoroscopically guided balloon dilation in the treatment of esophageal achalasia. MATERIALS AND METHODS: Under fluoroscopic guidance, 21 balloon dilation procedures were performed in 14 patients with achalasia. A balloon with a diameter of 20mm was used for the initial attempt. Ifthe patient tolerated this well, the procedure was repeated with a 10-20 mm balloon, placed alongside at the same session. If, however, the patient complained of severe chest pain and/or a postprocedural esophagogram showed an improvement, the additional balloon was not used. For patients whose results were unsatisfactory, the dilation procedure was repeated at sessions three to seven days apart. RESULTS: Succesful dilation was achieved in 13 of 14patients(92.9%), who needed a total of 20 sessions of balloon dilation, ranging from one to three sessions perpatient(mean, 1.54 sessions). Esophageal rupture occured in one of 14 patients(7.1%) ; of the 13 patients who underwent a successful dilation procedure, 12(92.3%) were free of recurrent symptoms during the follow-up periodof 1-56(mean, 18.5) months. The remaning patient(7.7%) had a recurrence seven months after dilation. CONCLUSION: Fluoroscopically guided balloon dilation seems to be safe and effective in the treatment of esophageal achalasia.