The patient, Li Mou (surnamed Li), 42 years old, began to have difficulty eating half a month before he was admitted to the hospital, and vomited on everything he ate. What’s worse, Li even had problems drinking water. Half a month down, Li lost weight to only 84 pounds. For half a month, Li barely ate and drank water, and went to the hospital to hang water every few days to save his life. Over the years, Li’s appetite has not been good, but never so serious. The company has been in several hospitals, some can not find the cause, some do not rule. A chance, Li came to the hospital, finally found the “real culprit”. The culprit is “cardia failure”: According to Professor Shi Ruihua, director of the Department of Gastroenterology at CUH, Li was very thin when he was admitted, his face was waxy, his ribs were clearly visible, and his abdomen was concave into a boat, clinically known as “eosinophilic body”. In combination with the symptoms and related findings, Li was diagnosed with “cardia incontinence”. “The cardia connects the esophagus to the stomach, and food reaches the stomach only after passing through the esophagus and cardia. The lower sphincter of the esophagus in cardia has a high pressure and a weak relaxation response to swallowing action, so the food that is eaten does not reach the stomach, and if the food stays in the esophageal cavity for a long time to stimulate the esophageal mucosa, it can cause esophagitis or even cancer. The only way to release the obstruction is to surgically cut the muscles around the lower end of the esophagus and completely solve the problem of eating difficulties.” Shi Ruihua told reporters. Due to Li’s extreme emaciation, poor brittleness of body tissues and severe malnutrition, there are certain risks associated with surgery, poor tolerance of surgery and anesthesia, and poor post-operative resistance to complications of infection. Considering the patient’s physical condition, Shi Ruihua gave the patient a treatment plan of supplemental fluid nutrition and elective surgery. After the patient’s physical condition stabilized, Shi performed the most advanced transoral endoscopic esophageal sphincterotomy to open a window in the superficial layer of the esophagus (mucosa) and then opened a tunnel in the submucosa. A tunnel is opened in the submucosal layer after the window is opened in the superficial layer of the esophagus (mucosa), and a tunnel is made along the interstitial layer of the esophagus (submucosa). The operation took only 30 minutes. The day after the operation, Li felt comfortable and could already drink some rice soup. After that, he recovered better and better, and had no problem eating semi-liquid food and drinking water without choking and coughing. Three days after the surgery, Li gained 6 pounds. In the past, the treatment of cardia achalasia included oral medication, endoscopic injection of drugs, balloon dilation and stenting, which had inexact efficacy and high recurrence rate; while surgical incision of the lower esophageal sphincter had exact efficacy, but the surgery was traumatic and recovery was slow. “‘Transoral endoscopic esophageal sphincterotomy’ is a minimally invasive surgery, which not only overcomes the problems of inaccurate efficacy and high recurrence rate of traditional treatment methods, but also has short operation time, small trauma, fast recovery and reliable efficacy, so that patients who originally need to undergo surgical operation are free from the pain of opening a large knife. “ The pathogenesis of achalasia has not been clarified and there are no international prevention programs. Symptoms such as dysphagia, food reflux and lower retrosternal discomfort or pain should be investigated for cardia as early as possible and treated early to avoid long-term retention of food in the esophageal lumen causing esophagitis or even cancer.