Esophageal bypass with a gastric tube and a cardiostomy is a method recently devised for malignant esophagorespiratory fistula. This method separates completely the alimentary and respiratory tracts. Four patients underwent these procedures. No operative deaths occurred, nor was there any anastomotic leakage or disruption of the excluded esophagus. The average survival time was 7 months. However, all patients were allowed to consume food orally up to the last moment of life. This bypass procedure is simple and safe to perform, and is thus a feasible treatment choice for patients with such fistulas.