Open peroral endoscopic myotomy for achalasia with sigmoid-shaped esophagus

A 54-year-old woman sought clinical consultation because of a > 27-year history of dysphagia. She had an Eckardt score of 13 and was diagnosed with sigmoid-type achalasia (S2 type, type II) based on esophageal motility testing, upper endoscopy, barium esophagography, and clinical presentations.