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Treatment of achalasia with botulinum toxin injection guided by endoscopic ultrasonography in a patient with esophageal varices.

Achalasia is characterized by incomplete lower esophageal sphincter (LES) relaxation and aperistalsis of the esophagus. It is manifested by regurgitation, dysphagia and weight loss. Treatment options include addition of pharmacotherapy, endoscopic dilatation, botulinum toxin injection (BTI) and surgical myotomy. The presence of esophageal varices makes endoscopic treatment difficult and therefore increases the risk of complications. Endoscopic ultrasonography (EUS) allows identification of esophageal varices while providing security in the therapeutic intervention (1). We present a patient with esophageal varices and achalasia in which it was treated with EUS-guided ITB.