The final aim of the treatment of oesophageal atresia is to restore continuity without the interposition of intestinal segments. The authors present the results of a new diagnostic method combining endoscopy and radiology to evaluate the development of pouches in oesophageal atresia. This new method has been successfully adopted in four patients aged between 4 and 8 months, three with type I and one with type III complicated atresia. Direct end-to-end anastomosis was performed in all patients. We think this method can be easily applied and is a suitable diagnostic examination in all cases in which surgical strategy aims at restoring oesophageal continuity by means of direct anastomosis.