An 84-year-old male, previously treated in 2015 with subtotal gastrectomy for gastric adenocarcinoma, presented in 2025 with Siewert type II cardial carcinoma detected on follow-up OGD. He underwent total gastrectomy with Roux-en-Y esophagojejunal mediastinal anastomosis. Postoperatively, septic shock, anastomotic leak, periesophageal collection, and pleural effusion occurred. Endoscopy confirmed leak communicating with mediastinal abscess and pleural cavity, demonstrated by methylene blue. Eight sessions of endoscopic VAC therapy were performed. During the first six, the sponge was placed intracavitary, achieving granulation and cavity reduction with clinical improvement. In the last two, it was positioned intraluminally adjacent to the leak. Endoscopic and radiological studies confirmed closure. The patient resumed oral intake and was discharged to a rehabilitation facility.