Retrospective analysis was carried out among 252 patients with esophageal achalasia (135 women, 117 men, mean age 41 years) who, in the years 1961– 1992, underwent 333 Starck procedures. Mean period of follow-up was 11.5 years (range 6 months to 32 years). Evaluation of the procedure was based upon the analysis of actual symptoms and radiological and endoscopic examinations in a group of 247 patients (98%). 22 patients died; all except 1 of diseases unrelated to the esophagus. The data concerning the effectiveness of therapy refer to the remaining 225 patients. The first Starck procedure gave permanent and sufficient relief of symptoms in 140 patients (62.2%). Of the remaining patients, 62 persons underwent subsequent Starck procedures, the effectiveness of which was 64.9%. The total percentage of favorable results of the procedure was 84.4%. There was no fatal complication of the Starck procedure. One perforation of the esophagus, one aspiration pneumonia and 2 cases of incarceration of the Starck apparatus were observed. There was no case of esophageal cancer in the whole group. These results confirm that the Starck procedure is a safe and effective treatment for esophageal achalasi