Approximately 50% patients with achalasia who are treated initially with a single pneumatic dilation will require further therapy within 5 years, and subsequent pneumatic dilations are progressively less likely to result in a sustained remission. Therefore, other forms of therapy should be considered after two or three unsuccessful pneumatic dilations.
I suggest a repeat dilatation, with a larger balloon size (the range is 2.4 to 5.0 cm) and if that again results in recurrence, you should consider surgical myotomy.