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Fig. 1. The initial examination findings. (A) The initial upper endoscopy shows a contracted esophagogastric junction. (B) The initial chest computerized tomography shows diffuse mild luminal distension without distal obstructive lesion at the esophagus. (C) The initial esophagogram shows a distal esophageal narrowing with impaired contrast flow. (D) The initial HRM shows an increased IRP (black arrow) and normal peristalsis (white arrow). HRM, high-resolution manometry; IRP, integrated relaxation pressure.
Fig. 2. Peroral endoscopic myotomy. (A) Submucosal tunnel. (B) Termination of endoscopic myotomy. (C) The entry site is closed with a clipping device.
Fig. 3. The follow-up examination findings. (A) Follow-up upper endoscopy shows a small scar (arrow) at the entry site. (B) Follow-up esophagogram shows an improved contrast flow disturbance. (C) Follow-up HRM shows a decreased IRP (black arrow) and weak peristalsis (white arrow). HRM, high-resolution manometry; IRP, integrated relaxation pressure.
