The effects of pyloroplasty following subtotal oesophagectomy and gastric substitution with cervical oesophago-gastric anastomosis were studied in a prospective randomized trial. 52 patients received extramucosal pyloroplasty and were compared to a control group of 55 patients, in whom no drainage procedure was performed. 6 patients died postoperatively. One of these patients died following the insufficiency of pyloroplasty. The other causes of death were not related to the performance or non-performance of pyloroplasty. Regarding to patients subjective self-assessment of abdominal discomfort and radiologic emptying of the gastric tube no statistical significant differences between both groups were noted 2 weeks and 6 months postoperatively. Two patients with pyloroplasty, but no patient of the control group, suffered 12 months postoperatively from severe vomiting due to fibrotic stricture of the pylorus. The results of this study suggest, that usually no pyloroplasty should be performed following subtotal oesophagectomy and interposition of a gastric tube with oesophagogastric anastomosis in the neck.