Helpful technical notes for intraperitoneal natural orifice transluminal endoscopic surgery (NOTES) salvage in a failed EUS-guided gastroenterostomy scenario.

1 a Balloon dilation of a lumen-apposing metal stent (LAMS) to allow scope passage; b, c jejunal loop seen through the misplaced LAMS; d suctioning of small bowel into the transgastric LAMS before cutting with a needle-knife. Under endoscopic/fluoroscopic guidance, deploy a second coaxial rescue stent within the misplaced stent to create a bridge between the small bowel and the stomach. [Extracted from the article]