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Background: One of the more challenging aspects of a proximal or total gastrectomy is the esophageal anastomosis. High leak rates and benign strictures have been reported. While stapling techniques may decrease leak rates, technical difficulties remain for both open and laparoscopic stapled esophageal anastomoses. Objective: We have employed a novel, double-stapled technique for open and laparoscopic esophageal anastomoses and present our initial series of patients. Design/Setting: Between September 2007 and November 2009, 24 consecutive patients underwent total or proximal gastrectomy. Patients: All individuals undergoing gastrectomy for cure, prophylaxis or palliation were included. Intervention: After completion of the gastrectomy, the OrVil anvil is passed transorally and the delivery tube is brought through an enterotomy adjacent to the distal stapled esophagus. Following detachment of the delivery tube, an intracorporeal double-stapled esophageal anastomosis is performed, passing the EEA stapler through an abdominal incision. Main Outcome Measures: Medical records were reviewed and short-term outcomes were categorized. Results: We performed 19 laparoscopic gastric resections (n=15, total; n=4, proximal), and 5 open total gastrectomies. There was no conversion from laparoscopic to open, and all anastomoses were performed without esophageal injury. There was no perioperative mortality or leak. Over a median follow up period of 6.7 months (range: 0.4-26.9), one patient developed an anastomotic stricture requiring dilation. Conclusions: Transoral delivery of the OrVil device through an enterotomy adjacent to the stapled distal esophagus is safe and facilitates the straightforward performance of an esophageal anastomosis. This double-stapled method should be considered a routine measure for the safe and expeditious performance of esophago-enteric anastomoses.