A 75-year-old man presented with complete proximal esophageal obstruction. Nutrition was maintained via gastrostomy after total laryngectomy with neopharynx creation and radiotherapy for laryngeal cancer six years earlier. Endoscopic gastropexy was first performed to protect the fistulous tract. The gastrostomy was dilated to 18 mm and a 9 mm scope was advanced through the fistula into the esophagus. Progressive  dissection with an ESD knife recreated a 6 cm neo-lumen toward the hypopharynx. For the final 2 cm, transillumination from an oral endoscope guided the rendezvous. The patient recovered uneventfully and undergoes weekly dilations at 15 mm. At 5 months of follow up, he can swallow liquids and soft food.