Since 1961 colonic replacement of the oesophagus has been performed in 38 patients of whom 16 were followed up long-term. The main indication was caustic soda injury to the oesophagus. We prefer a single-stage retrosternal isoperistaltic left colon interposition, based on the ascending branches of the left colic artery, with concomitant pyloroplasty. Oesophagectomy was not performed. The main complications were vascular insufficiency, upper anastomotic leak and subsequent stricture formation. Long-term follow-up (mean 9.5 years) revealed functional acceptance with normal swallowing, absence of pulmonary and gastrointestinal complications and rapid emptying of a passive conduit. Upper cervico-colonic anastomotic stricture of various degrees occurred in 14 per cent of the patients (5 of 35 patients).