It is difficult to decide on the best method of management for the double-channel pylorus because there is no agreement as to whether this uncommon condition is congenital or acquired. Of 60 cases reported in the literature 55 were associated with peptic ulcer disease strongly suggesting an acquired origin. A congenital origin should be accepted only if specific criteria obtain: (a) presence in early childhood, (b) presence of mucous, lamina propria and muscularis mucosae on microscopic examination and (c) characteristic findings as fluoroscopic examination. The authors report three patients with a double-channel pylorus. In one a prepyloric ulcer immediately preceded the development of the false antroduodenal channel. The other patients had peptic ulcer disease. All were treated conservatively. Operation is unnecessary except for complications that may arise. The authors' cases demonstrate that unless the diagnosis of double-channel pylorus is considered the radiologic and endoscopic findings may be misinterpreted.