Overtube and over-the-wire, through-the-scope balloon-assisted ERCP in a patient with complex hypopharyngeal stenosis after neck surgery.

A 64-year-old man with T2N0 squamous cell carcinoma of the tongue base underwent treatment with radiation, followed by glossolaryngectomy, bilateral neck dissection, and placement of an anterolateral thigh flap graft. After 1 year, he presented with acute cholangitis (abdominal pain, jaundice, fever, chills, and hypotension), making emergency endoscopic retrograde cholangiopancreatography (ERCP) mandatory. A computed tomographic scan of the neck showed hypopharyngeal stenosis and neck swelling as a result of the previous surgery (●" Fig.1a, ●" Video1). At another institution, emergency ERCP had failed, and the patient was transferred to our institution for further treatment. On standard esophagogastroduodenoscopy, the changes due to the prior com-