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Background: Esophageal 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 methods: In 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.Results: Esophageal lumen patency was re-established with "CARE PEP-guide wire" method without complications.Conclusions: In patients with complete esophageal introital obstruction, CARE PEP based approach can potentially re-establish the esophageal introital patency.

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