A 65-year-old male who had received definitive chemoradiation therapy for cuT3N0 esophageal squamous cell carcinoma (SCC), with an initially complete clinical response, was found to have recurrent cancer 2 years later located at 30 cm from the incisors on surveillance endoscopy. He underwent a salvage 3HMIE. A gastric conduit was constructed using serial firing of staplers. After creation of the conduit, perfusion was confirmed using Pinpoint fluorescence angiography (Novadaq Technologies Inc, Ontario, Canada) (Fig. 1a). A side-to-side, but functional end-to-end, esophago-gastric anastomosis was created in the left neck using staplers below the transition point. On postoperative-day (POD) 3, the patient developed acute respiratory distress and a CXR demonstrated a partial white-out on the right (Fig. 1b). He was emergently intubated, and a bedside bronchoscopy was performed which did not demonstrate a mucus plug. Therefore, a right-sided pleural effusion was suspected and a second chest tube was placed that did not resolve the effusion (Fig. 1c). Due to a concern for an anastomotic leak, he was taken for a thoracoscopic exploration and neck drainage. Multiple serous fluid collections were found in the right chest with a significant amount of diffuse thick rind, requiring decortication (Fig. 1d). An on-table endoscopy revealed ischemic changes of the gastric conduit spanning about 2 cm at 24 cm from the incisors. The anastomosis was intact at 20 cm. This suggested partial necrosis of the conduit and leak from the staple line into the thoracic cavity. A 23 mm × 155 mm WallFlex partially-covered self-expanding metal stent (pcSEMS, Boston Scientific, Natick, MA) was deployed under fluoroscopy, and bridled in place using umbilical tape. A completion esophagram confirmed appropriate stent placement without an active leak (Fig. 1e). Final surgical pathology returned as ypT1bN0 stage IB SCC. Twenty-five days after the pcSEMS placement, repeat endoscopy and stent retrieval was performed. Upon stent removal, macerated mucosa underneath the stent was seen with a 1 cm defect approximately 4 cm below the anastomosis. An on-table esophagram confirmed a small contained leak at the gastric conduit staple line, which prompted re-placement of a pcSEMS. Two weeks later, the second pcSEMS was removed, and the leak site was found to be completely healed. He was started on a liquid diet and gradually advanced to a regular diet. Two months later, the patient developed a stricture just below the anastomosis (Fig. 1f) that required serial balloon dilations with Kenalog (Bristol-Myers Squibb, Princeton, NJ) injection with complete resolution of symptoms after 6 months.