Combined Antegrade and Retrograde Endoscopy (CARE) with Pharyngo-esophageal Puncture (PEP) for Complete Esophageal Introital Obstruction

BackgroundEsophageal introital stenosis is common in patients who receive radiation therapy for laryngeal and hypopharyngeal cancers. Infrequently, complete obstruction develops within the esophageal introitus.Patient and methodsIn this video manuscript, we present a case of complete introital obstruction in which flexible endoscopic therapy was successfully by performing combined antegrade and retrograde endoscopy (CARE) and pharyngo-esophageal puncture using guide wire (PEP-guide wire), in combination with balloon dilation.ResultsEsophageal lumen patency was re-established with “CARE PEP-guide wire” method without complications.ConclusionsIn patients with complete esophageal introital obstruction, CARE PEP based approach can potentially re-establish the esophageal introital patency.