Transgastric retrograde endoscopic disimpaction in advanced achalasia.

Achalasia is an esophageal motility disorder that may lead to severe esophageal dilation and food impaction in advanced stages. We report a 54-year-old man with known achalasia who presented with massive esophageal food impaction. Initial endoscopic management failed to achieve complete disimpaction despite prolonged attempts. A multidisciplinary approach was undertaken, performing a transgastric retrograde endoscopic access combined with pneumatic dilation of the lower esophageal sphincter. This strategy enabled complete removal of the impacted material and subsequent esophageal clearance. The patient had a favorable clinical outcome and was scheduled for definitive surgical treatment. Massive food impaction in advanced achalasia is rare and may be refractory to conventional endoscopic techniques. Combined endoscopic-surgical approaches may offer an effective alternative in selected cases.