Due to early postoperative anastomotic leak after total gastrectomy, a fully-covered stent was deployed. Given the long-term persisting leak and laparotomic approach, PEJ was indicated and EUS-guided guidance proposed. A linear echoendoscope was advanced across the esophago-jejunal stent. Transillumination identified a compressible abdominal location suitable for PEJ. An endosonographic target was created placing a saline-filled sterile glove on the skin, which was then punctured with a 19G needle. A guidewire was exteriorized and tied to the kit string, which was then pulled across the abdominal wall from the mouth. Then, a standard “pull” technique was used. To increase the distance from the distal margin of the stent, the PEJ was extended distally via an 8Fr feeding tube. Two months later, after fistula healing and stent removal, PEJ was removed.