Purpose The optimal management of achalasia in children and adolescents remains unclear. The aim of this study was to review a single institution experience of endoscopic and surgical interventions in children with achalasia. Methods A retrospective review was conducted of the medical records of children treated for achalasia from 1978 to 2008. Patient demographics and interventions were reviewed. Outcomes after procedural intervention were evaluated. Results 35 patients with achalasia were identified, and data were available for 34 (age 13±6 years, male 62%). 18 patients underwent esophageal dilation (ED), and 16 patients underwent Heller myotomy (HM). Follow-up was available for 30 patients (15 ED, 15 HM). There was symptom recurrence in 15/15 ED cases and 8/15 (53%) HM cases (p<0.01). Additional interventions were performed in 14/15 (93%) ED cases and 6/15 (40%) HM cases (p<0.01). Conclusions Heller myotomy may provide more durable long-term outcomes, as defined by symptom recurrence and need for subsequent intervention, and may be considered the procedure of choice.

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