Achalasia is incurable, however the symptoms may be alleviated in many ways;
The disadvantage of the surgical treatments is that they involve surgery. The advantage is that they are more effective and durable than the non-surgical treatments.
A possible disadvantage of botox injections and pneumatic dilatation is that they delay myotomy so that the final result may not be as good as it may have been.
The disadvantages of botox injections is that the effect is short lived and injections need to be repeated. In addition the injections will cause fibrosis in the esophageal submucosa so that myotomy is more difficult and dangerous.
The disadvantages of pneumatic dilatation is the risk of esophageal perforation with its attendent morbidity and mortality. Myotomy is also more diffult and dangerous. Most patients will require repeated dilatation and each is accompanied by the risk of esophageal perforation.