Background: The NOTES team (surgeon and gastroenterologist) at Baystate has extensive experience with animal work in developing novel techniques with commercially available products. While we have not ever performed a cystgastrostomy on an animal, there is no known animal model to simulate this pathologic condition. We have, however, operated the flexible gastrointestinal anastomotic stapler translumenally in an animal model in order to prepare for this procedure. The surgeon on the team has performed human stapled cystgastrostomies before, via both open and laparoscopic approaches. A pilot case has recently been done performed and the patient continues to do well.