Inclusion Criteria:  diagnosed with esophagogastric junction outflow obstruction by high resolution manometry  Exclusion Criteria:  previous upper gastrointestinal surgery significant medical co-morbidities eosinophilic esophagitis severe reflux esophagitis (LA-classification C or D) large hiatal hernia patients experiencing significant weight loss suspicious for malignancy Vulnerable populations such as cognitively or decisionally impaired individuals, children, pregnant women, prisoners, and students or employees of the University of Kansas Health System or Medical Center