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. 2023 Jun 21;11(6):E581–E587. doi: 10.1055/a-2085-3866

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The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

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Fig. 2 — Descriptive illustrations USA-EGB procedure. a A balloon-assisted enteroscope is advanced into the small bowel. b The enteroscope and overtube are manipulated until the loop of small bowel located immediately downstream from the overtube balloon, overlaps the gastric silhouette on fluoroscopy. The “target segment” (meshed lines) within this loop of small bowel that is ideally suited for LAMS placement, is the segment of bowel that also overlaps a hypothetical 3- to 5-cm tubular zone that starts at the gastric inlet, runs along the lesser curvature, and ends at the pylorus (orange). The small bowel is then infused with a solution of water, radio contrast and a blue dye. The enteroscope is then withdrawn, leaving the overtube with an inflated balloon in situ. c A curvilinear echoendoscope is inserted alongside the overtube and the LAMS is deployed within the “target segment” (meshed lines) of small bowel. d Closure of the pylorus using a single continuous polypropylene suture. e Reduction of gastric volume by application of transmural sutures. f Completed USA-EGB procedure depicting complete gastrointestinal bypass and gastric restriction. Source: Image courtesy of Elena S. Kakoshina.