We present a 65-year-old man with a history of a Roux-en-Y gastric bypass and an ampullary adenocarcinoma, treated initially with a Whipple operation, who developed chronic left upper quadrant pain as a consequence of retained gastric contents within a dilated gastric remnant that was no longer in continuity. This was treated successfully with the endoscopic ultrasound-guided creation of a gastrogastric conduit via a covered metal stent. This represents a unique complication of pancreaticoduodenectomy in patients with a prior Roux-en-Y gastric bypass.