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A, Excluded stomach puncture. B, Wire in excluded stomach. C, Tract dilation. D, Distal flange of lumen-apposing metal stent (LAMS) in the excluded stomach. E, Fully deployed LAMS connecting gastric pouch and excluded stomach. F, Duodenoscope through the lumen of the LAMS. G, Impacted stone in the lower common bile duct. H, LAMS in place at the end of the procedure.
