case_images: PMC3959450_01
case_images: Upper gastrointestinal endoscopy: esophageal varices
case_images: AnnGastroenterol-26-258-g001.jpg
case_images: PMC3959450_01_AnnGastroenterol-26-258-g001.jpg
case_images: F1
case_images: Esophageal varices were also noted but there was no history of gastrointestinal bleed (Fig. 1).
case_images: Manometry showing high resting lower esophageal sphincter (LES) pressure with partial transient LES relaxation (P4-P6) and non transmitted low amplitude esophageal body contractions suggesting achalasia cardia
case_images: AnnGastroenterol-26-258-g002.jpg
case_images: PMC3959450_01_AnnGastroenterol-26-258-g002.jpg
case_images: F2
case_images: Esophageal manometry revealed high resting lower esophageal sphincter (LES) pressure with non transmitted low amplitude contractions in esophageal body (Fig. 2) suggesting classic achalasia cardia.
case_images: EUS: perforator vessel on power Doppler
case_images: AnnGastroenterol-26-258-g003.jpg
case_images: PMC3959450_01_AnnGastroenterol-26-258-g003.jpg
case_images: F3
case_images: Endoscopic ultrasound (EUS) examination revealed peri-esophageal collaterals as well as prominent perforators at lower end of esophagus (Fig. 3).
case_images: EUS-guided botulinum toxin injected in lower esophageal sphincter
case_images: AnnGastroenterol-26-258-g004.jpg
case_images: PMC3959450_01_AnnGastroenterol-26-258-g004.jpg
case_images: F4
case_images: Using a linear echoendoscope with color Doppler, carefully avoiding varices and perforators, 80 units of botulinum toxin was injected into LES in four quadrants (20 units in each quadrant) (Fig. 4).