Introduction: Esophageal anastomotic leaks following gastric or esophageal cancer surgery remain a major cause of morbidity and mortality. To limit the risks associated with operative repair, endoscopic interventions, including stenting, clipping, and percutaneous endoscopic jejunostomy (PEJ), have been increasingly used to manage these patients. The study aimed to determine the efficacy of endoscopic management of esophageal anastomotic leaks following cancer surgery. Methods: We performed a retrospective review of prospectively maintained databases of all gastric and esophageal operations at our hospital. Included patients had esophageal or gastric cancer and were operated on between January 2003 and December 2012. Patients with radiographic or endoscopic evidence of an anastomotic leak and who underwent an attempt at endoscopic management were included. Results: Of the 107 patients with esophageal anastomotic leaks, 51 underwent an attempt at endoscopic management. Forty were men, and the mean age was 61. Forty-two patients underwent esophagectomies, 6 had partial or total gastrectomies, and 3 had esophagogastrectomies. Fully covered esophageal stents were placed in 32 patients. On average, stents were in place for 59 days (range 12-170 days). Stent migration was seen in 34% of patients and managed with endoscopic revision. There were no other documented complications from stent placement. Overall, 26 patients (81%) treated with stents healed. Direct PEJs were placed in 41 patients for a mean duration of 106 days (range 18-358 days). Four patients failed PEJ placement and required a second attempt for successful insertion. There were no documented complications from PEJ placement. Overall, 39 patients (95%) treated with PEJs healed. Endoscopic clips were placed in 3 patients, all of whom also received stents. There were no documented complications related to clipping, and all 3 patients healed. Among these groups, 22 patients were treated with stent and PEJ. Healing was seen in 21 out of 22 (95%) of these patients in a mean of 105 days (range 31-337 days). Of the 51 total patients, 44 (86%) achieved documented anastomotic healing. Mean healing time was 92 days (range 3-337 days). Of the remaining 7 patients, 3 required anastomotic revision, 1 required esophageal exclusion, 2 died of multiple surgical complications, and 1 died at another facility with stent in place. Conclusion: Our results suggest that anastomotic leaks can be managed safely and successfully with endoscopic therapy in select patients. A combination of esophageal stenting to control the leak and PEJ placement for nutrition was highly effective in achieving anastomotic healing, without the need for highrisk operative repair.