On the basis of 26 cases with non-operable primary or secondary neoplastic obstructions of the cardia the authors express the opinion that the best solution is the transdiaphragmatic pontage with a jejunal loop mounted in Y. Enlargement of this indication should not be made on behalf of radical or palleative resections, but on the contrary internal derivations should increase the range of surgical solutions in cancer of the cardia. Making an analysis of the major aspects (death-rate, indications and some technical details) in connection with the by-pass with a Roux loop the authors stress the benignity of this type of surgery and the chances it has to take the place of external derivations, compared with which it provides both nutritional and moral advantages.