In all the cases of P.V Syndrome, it is better to find out by endoscopy even if barium swallow is normal. Thus in P. V. syndrome, the accuracy of barium swallow is only 19% and 81% are reported as false negative.In strictures and malignancies, the level of lesion reported by barium swallow should not be relied upon in all the cases, and they should be confirmed by endoscopy.Endoscopy provides us with a definite diagnosis and allows biopsy and hence histological confirmation. Barium Swallow is an important examination that can be used to rule out certain lesions. So endoscopy can be avoided in these patients. Failure rate of Barium Swallow can mostly.