This video describes the symptoms, radiological findings by barium swallow and cinefluorography, and the manometrics of a patient having a hypertensive lower esophageal sphincter, and a large epiphrenic diverticulum. Resection of the diverticulum, esophago-cardiomyotomy and modified Belsey IV anti-reflux procedure are shown. A 23-year follow-up is included.