A 62-year-old man presented with a 4-month history of dysphagia to solids and weight loss of 10 kg.
The patient suffered from Child-Pugh stage B8 ethylic liver cirrhosis.
Gastroscopy revealed dilatation and atonia of the esophageal body, as well as three medium-sized varicose cords in the lower third.
Barium transit showed esophageal dilation with distal tapering.
Manifestations evidenced absence of peristalsis in the esophageal body.
Abdominal CT ruled out the existence of regional neoplasia.
Six patients had dysphagia score of 9 points (2).
With the diagnosis of achalasia and after assessing the different therapeutic options, it was decided to perform an ABI guided by endoscopic ultrasound.
Medium echoend stenosis EG-3830UT was located as a thickened hypoechoic area (7 mm) in continuity with the muscular layer of the esophageal wall.
In this area, 22 G EchoTip Ultra (COOK Medical), one ml of botulinum toxin (20 IU) (BoTox; Inc., I/5
There were no complications and the patient tolerated a solid diet in 72 hours.
At 9 months of evolution the patient only referred occasional dysphagia, scoring 1 out of 9 in the dysphagia score.
