Open peroral endoscopic myotomy for refractory benign esophageal stricture

A 36-year-old woman suffered thoracic pain and dysphagia following a barbecue 6 months earlier. Gastroscopy showed an ulcer in the lower esophagus. The thoracic pain disappeared after taking proton pump inhibitors (PPIs) for a week, but dysphagia continued. Repeat gastroscopy showed a thickened and rigid lower esophageal wall and esophageal stricture ([Fig. 1 a]). The stricture was about 4.0 cm from the cardia. Endoscopic biopsy diagnosed inflammation. Esophagography showed severe stricture in the lower esophagus ([Fig. 2 a]). Thoracic computed tomography showed a thickened lower esophageal wall, and endoscopic ultrasonography showed thickening of the muscularis propria in the lower esophagus ([Fig. 3]), without manifestation of tumors. The patient continued to take PPIs and underwent three sessions of endoscopic dilation, without success; she lost 8.0 kg in weight.