BACKGROUND Pancreaticoduodenectomy is a technically demanding operation, with reported morbidity rates of approximately 40%–50%. A novel idea is to use endoscopic vacuum therapy (EVT) in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas. In a recent case series, EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia. There have been no previous reports on preemptive EVT after pancreaticoduodenectomy. CASE SUMMARY We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice, choluria, fecal acholia, abdominal pain, and fever. Admission examinations revealed leukocytosis and hyperbilirubinemia (total: 13 mg/dL; conjugated: 12.1 mg/dL). Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct. Magnetic resonance imaging demonstrated a stenotic area, and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreatico-duodenectomy, preemptive endoluminal vacuum therapy was performed. The system comprised a nasogastric tube, gauze, and an antimicrobial incise drape. The negative pressure was 125 mmHg, and no adverse events occurred. The patient was discharged on postoperative day 5 without any symptoms. CONCLUSION Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.

Background: Granular Cell Tumors (GCT) are rare benign neoplasms with an estimated prevalence of 0,4% in retrospective series. About 8% of GCT are located in the gastrointestinal tract, having the esophagus as the main affected area. Malignancy was reported in 2-4% of cases and there are no well established treatment protocols. Case summary: It was present an oligo-symptomatic female patient with diagnosis of GCT presented on the endoscopy. Complementary investigation was based on endoscopic ultrasound (EUS). The treatment consisted of mucosectomy and endoscopic variceal ligation, evolving with a favorable outcome. Conclusion: Despite disagreement on protocols for treatment of GCT, mucosectomy appears to be an effective option.