Background: Approximately 4% of patients develop a second upper
gastrointestinal cancer after
esophagectomy, and nearly 60,000 people are diagnosed with
pancreatic cancer in the United States each year. The need for a Whipple procedure after
esophagectomy is rarely reported. Post-
esophagectomy anatomy, particularly the vascular supply, makes this a complex operation. Herein, we describe the advanced endoscopic rescue of a duodenojejunostomy (DJ) leak after pylorus-preserving
pancreaticoduodenectomy (PPPD) in a post-
esophagectomy patient. Presentation: A 72-year-old male with a remote history of
esophageal cancer treated with minimally invasive three-hole
esophagectomy and chemoradiation presented to our institution for evaluation and management of newly diagnosed
pancreatic cancer. The patient had undergone common bile duct (CBD)
stent placement by his gastroenterologist 2 weeks earlier after experiencing
jaundice,
weight loss, and
steatorrhea. Endoscopic ultrasound confirmed the presence of a pancreatic head and neck mass, obstructing and dilating the main pancreatic duct and CBD. Fine-needle biopsy revealed a poorly differentiated
adenocarcinoma. A PPPD was performed without
intraoperative complications. The patient was subsequently readmitted with a DJ leak requiring interventional radiology and advanced endoscopic intervention. Conclusions: PPPD in patients with
pancreatic cancer can be performed after previous
esophagectomy. Careful dissection is crucial to avoid injury to the remaining right gastric and right gastroepiploic arteries that supply the gastric conduit after
esophagectomy. The DJ is at risk after this operation, and access to tertiary care inclusive of interventional radiology and advanced endoscopic teams is critical to the correction and healing of a leak of this anastomosis.