Esophagorespiratory fistulas resulting from Mycobacterium tuberculosis infection are rare. Whereas most esophagorespiratory fistulas are absolute indication for direct surgical closure, this may not be necessary in the case of those of tuberculous origin. If diagnosed early, the infection and the complicating fistula could be treated effectively with anti- tuberculous chemotherapy without the need for surgical intervention. Despite the sugges- tion of a trend away from direct surgical closure in recent years, it seems that anti tuberculous chemotherapy may not result in healing of the fistula in all patients. So we report a case of tuberculous esophagorespiratory fistula that has severe aspiration pneumorua and effectively treated with implantation of silicone-covered self-expandable metal stent and antituberculous chemotherapy. (Karean J Gastrointest Endosc 18: 66- 70, 1998)