Injection of ethanolamine oleate into the four quadrants of the lower esophogeal sphincter has potential as a therapy for resistant idiopathic achalasia, according to the findings of Niknam et al. In this study, 13 patients underwent treatment (at week 0, 2 and 4) and all had a ≥50% reduction in both the achalasia symptom score and the height and volume of barium in a timed barium esophagogram. The treatment was well tolerated. Six patients experienced symptom relapse, but were effectively treated by reinjection of ethanolamine oleate.