Endoscopic approach to achalasia

Figure 1 Endoscopic images of botulinum toxin injection. Injection with the standard sclerotherapy needle deep intramuscular in the region of the cardia. A: Prograde injection with an endoscopic view of the distal esophagus; B: Retrograde injection with a retroflexed view of the cardia.

Figure 2 Radiologic image of the esophagus of an elderly patient. A: Before Botox injection; B: After Botox injection, with a decrease of the diameter in the area of the lower esophageal sphincter.

Figure 3 Pneumatic dilation with a rigiflex balloon. A: Endoscopic image; B: Radiologic images. The waist of the balloon lies in the region of the lower esophageal sphincter.

Figure 4 Endoscopic images of patients with achalasia. A: Early achalasia; B: Advanced achalasia with a megaesophagus, hyperplasia of the esophageal epithelium.