Left: Retained content with an air-fluid level in the esophagus of an 87 year-old man with difficulty swallowing.
Center: Appearance of the distal esophagus in an 83 year-old woman who with difficulty swallowing solids and liquids. Barium xray was suggestive of achalasia. Endoscopy revealed retained esophageal content with an air-fluid level in a dilated, tortuous esophagus, a high pressure zone at the esophagastric junction, and the absence of true stricture or neoplasm.
Right: 84 year-old woman with achalasia. Endoscopy revealed retained content within the esophagus, with an air-fluid level. Symptoms responded well to injections of botulinum toxin.
Left: Retained content and air-fluid level in the dilated esophagus of a 54 year-old woman with several years of progressive dysphagia.
Right: View of lower esophageal sphincter zone, which never relaxed more than a few millimeters.
Left: 45 year-old man presented with a six months of progressive dysphagia and worsening postprandial vomiting of undigested material. Ensoscopy revealed a dilated esophagus, retained content, and a lower esophageal sphincter which failed to relax. Photo was taken just prior to injection with botulinum toxin.
Center: Barium swallow had demonstrated a dilated esophagus and a typical "bird-beak" deformity of the esophagogastric junction consistent with achalasia.
Right: Lower esophageal sphincter zone showing prompt relaxation just after submucosal injection with botulinum toxin.
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