Corkscrew esophagus (also referred as rosary bead esophagus) is a classic fluoroscopic appearance of diffuse esophageal spasm (DES) in barium studies. It reflects interruption of the normal peristalsis by multiple, repetitive, non-propulsive esophageal contractions (tertiary peristaltic waves) that are more commonly seen in mid and lower thoracic esophagus [1].

These abnormal contractions cause luminal obliteration interspersed with barium-containing segments, leading to compartmentalization and curling of the esophagus, resembling the appearance of a corkscrew or rosary beads [2]. (Figures 1, 2 and 3).

Fig. 1
figure 1

Barium study sequence of images from two patients. A in right oblique view and B in frontal projection showing multiple tertiary peristaltic waves in the distal thoracic esophagus leading to a curling and compartmentalization of the esophageal lumen, resembling a corkscrew or rosary beads

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Fig. 2
figure 2

A corkscrew

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Fig. 3
figure 3

Prayer (rosary) beads

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The diagnosis of DES is based on the typical imaging appearance, along with appropriate manometric findings and sometimes chest pain.