Endoscopic suturing with the OverStitch device is safe and effective for a wide range of applications from defect closure and stent fixation to hemostasis and bariatrics. OverStitch-related complications remain rare, although adverse events such as bleeding, mucosal injury, perigastric fluid collections, leaks, and perforations have been reported. Provider familiarity with the device and the specific pitfalls that may arise with OverStitch use in different situations is necessary to minimize the risk of adverse events. This article reviews potential complications and provides tips and troubleshooting techniques.