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Competing Interests: Disclosure Dr Mehta is a consultant for Boston Scientific and Castle Biosciences. Dr Singh is a consultant for Boston Scientific. Dr Chapman is a consultant for Boston Scientific, Olympus, Medtronic, Steris Endoscopy, Abbvie, and Phathom Pharmaceuticals. Dr Waxman is a consultant for Boston Scientific, Cook Medical, and Medtronic. All other authors disclosed no financial relationships relative to the content of this work. Commentary A bedrock principle for therapeutic EUS is to identify a target window from 1 lumen to the other lumen. Performing EUS-guided gastrojejunostomy can be challenging because from the stomach, the target jejunal loop can be small, and it is mobile within the abdominal cavity. Endoscopists have used various tools to distend a target jejunal loop, such as a nasobiliary drain or biliary extraction balloons, among others. However, the authors used the altered anatomy to their advantage. By advancing their endoscope into the small bowel, they easily identified the stomach (which is a much larger and more stable target for EUS-guided gastrojejunostomy) to successfully deploy the lumen-apposing metal stent. Monica Saumoy, MD, MS, Center for Digestive Health, Penn Medicine Princeton Health, Philadelphia, Pennsylvania, USA Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points