A 66-year-old man presented with severe dysphagia, weight loss and recurrent pulmonary infections due to an esophago-tracheal fistula. Due to squamous cell carcinoma of the esophagus 17 month ago, he had undergone esophageal resection and interposition of a gastric tube with cervical anastomosis. This treatment was followed by adjuvant radio-chemotherapy (50 Gy with 5-FU and Cisplatin). The first signs of dysphagia developed 8 weeks before admission to our hospital. Initial endoscopic therapy revealed local tumor recurrence beginning at 21 cm from front incisors, but failed to provide palliation of dysphagia. The distal end of the stenosis could not be measured precisely due to high grade stenosis which could not be passed endoscopically. Though intravenous hyperalimentation was administered, the patient kept on losing weight. Furthermore recurrent pulmonary infections occurred and swallowing of salvia, without coughing became impossible. For palliative surgical treatment the patient was transferred to our institution. Unfortunately we found the esophageal lumen to be completely obstructed by recurrent tumor. Moreover the tumor had invaded the trachea and had caused an esophago-tracheal fistula. The fistula itself could not be seen endoscopically, but was found by gastrographin swallow and CT-scan. According to CT-scan we estimated it to be located at about 2–3 cm distal from the beginning of the stenosis. The recurrent mediastinal tumor was estimated to have a length of 6 cm and infiltrated the gastric tube. All endoscopic attempts to pass the obstruction failed, because the guide wire only entered the associated esophago-tracheal fistula. Therefore a retrograde endoscopic approach was undertaken. According to the previous esophageal resection with interposition of a gastric tube, radiologically guided percutaneous gastrostomy techniques [] had to be rejected. Retrograde access to the esophageal lumen was obtained by open surgery and a duodenotomy. Through an endoscope a guide wire (Terumo, RF-GA35403M Standard, 0.035 inch) was pushed up and the esophageal obstruction was traversed, which simultaneously was monitored by a transnasal endoscope. Using a guiding catheter the esophageal stenosis was dilated and a naso-jejunal triluminal feeding tube was placed into the first jejunal loop. Subsequently the longitudinal duodenal incision was closed in a transverse fashion. Before closure of the abdominal wall a jejunostomy catheter was implanted to ensure sufficient enteral nutrition. 72 hours later, in a second step further endoscopic guided dilatation of the esophageal stenosis was repeated twice. Using a stiff wire (0.035 inch) placed under fluoroscopic control subsequent guide wired dilatation, up to 12.8 mm according to the method of Savary, was performed. In a third step a nitinol self-expanding fully covered stent, the so called Choo stent (M.I. Tech/MTW), was placed across the fistula under radiological and endoscopic control. After successful placement of the stent the upper end was located directly proximal from the stenosis at about 20 cm from frontal incisors and completely traversed the whole stenosis. As a result the patient felt neither foreign body sensation nor pain. A follow up contrast study, performed on the 4th day after stent placement, showed the stent to be almost completely expanded without any signs of persisting leakage. Thereafter the patient was allowed to swallow liquid food, although only a small volume could be swallowed at a time. A few days later swallowing of semi solids and hypercaloric liquid food was possible and the patient was discharged. Follow-up analyses revealed that the patient died 158 days after our treatment due to severe pleural effusion and diffuse pulmonary metastasis.