This 45 year old patient had been referred from another institution for balloon dilatation for achalasia of cardia. He had undergone an upper GI endoscopy and nothing unusual had been discovered. A barium swallow showed the classic bird beak lower esophagus (A: green arrow). The manometric findings also suggested classic achalasia. When we went in to dilate and retroflexed to view the fundus prior to wire insertion, the esophago-gastric junction was seen to be ulcerated and indurated (B:green arrow). We took biopsies (C: green arrow) and cancelled the dilatation till the biopsy report and a CT scan of the lower chest and abdomen.
