Indications for colon replacement of the esophagus include gastroesophageal malignancy; benign non-dilatable distal esophageal strictures caused by reflux esophagitis; extensive chemical strictures; benign tumors of the esophagus that are extensive or multiple and are not amenable to simpler measures; congenital atresia of the esophagus for which a primary anastamosis is impossible or impractical; rare cases of achalasia (megaesophagus) in which Heller myotomy fails or is complicated by malignancy; bleeding varices for which shunting fails or stricture formation follows disconnection operation; and rupture of the esophagus for which conservative repair fails or is impossible.

The right or left colon may be used, based on the right or left branch of the middle colic artery. Depending upon the surgeon's preference, the prepared colonic segment is passed through a retrosternal tunnel or brought into the posterior mediastinum through the right or left pleural cavity. An anastomosis is then constructed to the cervical esophagus. Regardless of the approach used, the procedure is of great magnitude. A general endotracheal anesthetic is administered and the procedure usually lasts 4 to 6 hours. Two to four units of blood are frequently required. Intensive preoperative preparation, including correction of fluid, caloric, and protein deficiencies, substantially improves outcome, particularly for elderly or debilitated patients. Careful mechanical bowel preparation is also required.