A 60-year-old woman presented with acute pancreatitiscomplicated by the development of acute pancreatic fluidcollection, which later organized into a large peripancreaticpseudocyst (Fig. 1). This was drained endoscopically with amonths later, she had a residual gastric fistula along theposterior gastric wall communicating with the pancreaticbed (Figs. 4-6). The opening was too big to be closedwith over-the-scope clips. We performed endoscopic suturing, which failed to close the fistula despite the achievement of good mucosal approximation.
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