PMC3959450_01
Upper gastrointestinal endoscopy: esophageal varices
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F1
Esophageal varices were also noted but there was no history of gastrointestinal bleed (Fig. 1).
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
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F2
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.
EUS: perforator vessel on power Doppler
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F3
Endoscopic ultrasound (EUS) examination revealed peri-esophageal collaterals as well as prominent perforators at lower end of esophagus (Fig. 3).
EUS-guided botulinum toxin injected in lower esophageal sphincter
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F4
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).