A 53-year-old man with diabetes mellitus and a history of Roux-en-Y gastric bypass had a bile leak after a cholecystectomy in March 2020. He subsequently underwent EUS-directed transgastric ERCP (EDGE) with gastrogastric fistula creation with a lumen-apposing metal stent (LAMS) (AXIOS, Boston Scientific, Marlborough, Mass, USA) followed by placement of a 10F × 10-cm plastic biliary stent in March 2020.