Every one has a different threshold for referring for surgery. I believe that an anti-reflux operation performed by a skillful and experienced surgeon on an appropriately selected patient can be satisfying and cost effective treatment for reflux esophagitis and its complications. A young patient with severe Gastro-Esophageal Reflux Disease may require years and years perhaps life long medical treatment. This entails lot of cost and while these drugs appear to be safe, long term effects are not known. Stricture not responding to dilatation requires esophagus replacement.
Perforation is a known complication of dilatation.
Strictures that can be dilated are usually treated by fundoplication. Patients with low grade dysplasia may be followed closely with aggressive acid suppression. High grade dysplasia need surgery because many of these pts have undetected malignancy. BEST chance of repair is the first one. Repeat anti-reflux procedures are much more technically difficult than the initial repair.