The use of the stomach is still the preferred substitute for the esophagus requiring only the anastomosis to reestablish food passage. Furthermore the gastric substitute acquires spontaneous propulsive contractility and is associated with good long-term functional results. In Western populations, tubular transformation of the stomach following lesser curvature resection, as described by Akiyama occasionally results in a short gastric tube with perfusion deficiencies at the cranial part of the tube.