The patient is a 55 year old female who has a history of a laparoscopic Roux-en-Y gastric bypass. She presented to the office with an 18 month history of dysphagia that first started to liquids and then progressed to solids. A barium swallow demonstrated a dilated and tortuous esophagus with no peristaltic activity. Esophageal manometry was also performed that showed absence of esophageal peristaltic waves and the esophagogastric junction was unable to be penetrated, consistent with Type 1 achalasia. She underwent an EGD, which did not demonstrate any masses. Considering these findings, she was advised to undergo a Heller myotomy for control of her symptoms.