Sir.—Achalasia is a rare condition in children. In 5% of adult patients, symptoms appear during childhood.1 Achalasia in patients younger than 14 years of age accounts for 2% of all patients. The onset is insidious and is characterized by difficulty in swallowing solids, regurgitation, choking, and recurrent pneumonia.2 Severe weight loss eventually follows. Barium swallow procedures and fluoroscopy are necessary for diagnosis.2 At present, Heller myotomy with or without an antireflux procedure and dilatation with a metal spreader or pneumatic bag are used.3 We report our preliminary experience with the new method of transendoscopic dilatation (TPD).
Patient Reports.—Patient 1.—A 12-year-old boy had achalasia for two years. His symptoms were dysphagia, postprandial regurgitation, coughing at night, and weight loss of 15 kg. Four months before admission, he was able to swallow only liquids. His weight was 30 kg; height, 156 cm. Esophageal fluoroscopy showed