Question: A 50-year-old man presented with complaint of recurrent nonbilious vomiting for 4 months and a weight loss of 66 pounds in the same time frame. Physical examination revealed a tympanitic mass in the epigastrium. Laboratory testing revealed no remarkable abnormalities except for hypoalbuminemia and hypokalemia. In view of recurrent vomiting, a Ryle’s tube was inserted and the gastric contents were aspirated. Esophagogastroduodenoscopy demonstrated a fistulous tract on the lesser curvature of the distal stomach in the region of antrum with undulating membranes gushing out from the communication (Figure A, Video).