Endoscopic ultrasound-guided bilio-pancreatic drainage (EBPD) has become an endoscopic alternative to percutaneous biliary drainage for patients with unsuccessful transpapillary approach. EBPD has a significant complication rate and expertise in advanced therapeutical endoscopy and endosonography are required. We present a 43 year-old male with pancreatic head adenocarcinoma, who after underwent a transgastric endoscopic rendez-vous technique, a gastric wall perforation at the fistula location was detected. We endoscopically sealed the gastric perforation and the patient had an uneventful recovery.