Endoscopic balloon dilatation has been used for more than 10 years for the treatment of peptic gastric outlet obstruction. Long-term outcomes in series from tertiary centers have shown a high rate of failure in several studies. We reviewed a series of patients treated with balloon dilatation in a community hospital to evaluate the effectiveness in this procedure and factors that would affect success rate. Forty consecutive patients who had successful initial balloon dilatation for benign gastric outlet obstruction were followed for at least two years or until death or surgical therapy occurred. Data were obtained from the gastrointestinal laboratory log book, hospital, and office records. Patients were also interviewed by telephone. Twelve patients had relief of obstruction by initial dilatation. The remaining 28 patients developed recurrent symptoms and 12 in this group eventually required surgery. Factors predicting referral for surgery included younger age, need for multiple procedures, technical failure of dilatation in four patients, and long duration of treatment course. Eradication of Helicobacter pylori was associated with successful relief of obstruction without surgery, whereas continued use of nonsteroidal antiinflammatory drugs was associated with recurrent obstruction. In the community hospital, endoscopic treatment is safe and is usually successful in relieving benign gastric outlet obstruction. Repeat dilation is often needed and long-term success will be improved by elimination of H. pylori infection and nonsteroidal antiinflammatory use.