THE USE OF THE COLON as a replacement for the diseased or injured esophagus has been tried with considerable success recently. For the past five years a series of patients with malignant disease of the upper esophagus have been treated at the Massachusetts General Hospital by techniques involving: esophagectomy followed by radiation therapy and later replacement of the esophagus with a section of the colon. In the case of unresectable lesions, palliative colon bypass alone may be used and sometimes followed by radiation therapy. While the detailed results of this series are not reported here, it has been demonstrated that the use of the colon as a replacement for the diseased esophagus is quite feasible, and the operative procedure may be carried out with a low mortality rate(l1). Of course, the technique, with the exception of the radiation therapy, is equally applicable to benign conditions of the esophagus. Prior to the past two decades surgical approaches to destructive conditions of the esophagus were limited to superficial procedures such as the creation of skin tubes for patients with strictures of the esophagus. In 1935, Ohsawa in Japan reported on the one-stage esophagogastric resection for carcinoma of the lower third of the esophagus with an anastomosis of the gastric remnant to the esophagus below the aortic arch(2). In this country, Adams and Phemister and Churchill and Sweet developed the procedure further until today this technique has become fairly well standardized as the method of choice for lower-third lesions (3,4).