The gastroscope is gently and atraumatically advanced to the descending duodenum. There the mucosa is found to be pink in clolration and feathery in texture. There was no indication of any atrophy to suggest celiac disease. The duodenal bulb does not have eschar or ulcer crater. The pylorus demonstrates no stenosis. A cold biopsy forceps is used to biopsy the pylorus times one so the the CLOtest can be performed. The gastric antral mucosa is a normal pink mucosa without erythema, ulceration, polyp or carcinoma. The corpus of the stomach and retroflex view of the gastric cardia is normal. Antegrade view of the squamocolumnar junction located at 40 com depth of insertion from the incisors, a small 2-3 cm intrathoracic hiatal hernia, a distal esophageal stricture, a Schatzki's ring. the esophageal mucosa is pale pinkish-white and smooth throughout without raised lesion, diverticulum, varices or carcinoma. The 50, then 54, and then 60- French dilators are passed to 50cm depth of insertion without resistance. Upon removal no blood is present on the dilator, but repeat endoscopy shows that there is blood in the esophagus, consistent with successful fracturing of the peptic stricture. then the distal esophagus is biopsied x4 one biopsy in all four quadrants. The patient is then return to this room in stable condition.