Fig. 3. Double balloon-occluded procedure. (A) A double-balloon-occlusion catheter is introduced inside the overtube. (B) The two balloons are inflated with 200 mL of dye to fix the bowel loop. The segment between the balloons is filled with a solution of saline and methylene blue. (C) Deployment of the distal flange of the lumen-apposing metal stent (LAMS). (D) Full deployment of the LAMS. (E) The distended bowel loop is located by echoendoscopy and then punctured with the electrocautery LAMS. (F) Endoscopic ultrasound-guided deployment of the stent. (G) Endoscopic view of the fully deployed LAMS. The double-balloon catheter is kept in place until confirmation of technical success.
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