Background: Pharyngoesophageal strictures (PES) affect 3–7% of patients submitted to head and neck as well as esophageal cancer therapy making such dilatation technically challenging.1 Objective was to describe the safety, overall efficacy and our experience with fluoroscopically guided Transnasal Savary–Gilliard (SG) dilations of esophageal strictures. We describe our innovative technique in patients with hypopharyngeal/cervical esophageal malignancy or stricture in who endoscopically guided guidewire placement was challenging or futile due to close proximity of such lesions to the oropharynx and hence no stability or support offered to the endoscopy tip for placement of the guidewire across the lesion. Methods: This study was a prospective cross–sectional study carried out at Madras Medical College, Institute of Medical Gastroenterology on all patients undergoing Transnasal Savary–Gilliard dilation from August 2018 to January 2019. Dilation was performed with Savary–Gilliard polyvinyl dilators (Wilson–Cook Medical) over a hydra guidewire (straight tip) that was advanced transnasal under fluoroscopy to the stomach. Patients were asked to answer a questionnaire determining prospectively the dilation program efficacy as dysphagia improvement, and any complication during and/or post procedure was recorded. Results: Fifty eight transnasal esophageal Savary–Gilliard dilations were performed on 50 patients. The mean age of the cohort was 57 years (37–71years). Thirty three patients were male (66%). Pharyngeal and cricopharyngeal region was the most frequent dilation site (96%). Indications included supraglottic squamous cell carcinoma (30%), hypopharyngeal carcinoma (26%), post–radiotherapy (post–RT) strictures for head and neck carcinoma (28%), stenosis of surgical anastomosis (8%), and corrosive stricture (8%). One procedure (2%) was aborted due to laryngospasm or gagging. There were no clinically significant complications. The mean predilation dysphagia Mellow–Pinkas score was 3 and the initial stenosis diameter was 6 mm, and 60% postdilation had dysphagia improvement. Conclusion: Transnasal esophageal Savary–Gilliard dilation can be performed in unsedated patients with a very low complication rate and in technically challenging cases by transoral route. The procedure was well tolerated in 98% of our patients. This technique formerly done only through endoscopy guidance and under sedation, allows for dilation as an outpatient procedure.