ENDOSCOPY IN REVERSIBLY ALTERED ANATOMY

Systems, devices, and methods for endoluminal transgastric access to the pancreaticobiliary anatomy are disclosed. An exemplary transgastric access technique comprises creating a reversible alteration of gastric anatomy using a closing device, including a reversible disconnection between a first gastric portion and a second gastric portion via an alterable gastric closure. The technique further includes, during an endoscopy procedure, passing a steerable elongate instrument into the first gastric portion, identifying the alterable gastric closure, and disengaging at least a portion of the alterable gastric closure using an endoluminal disengaging device to at least partially reconnect the first and second gastric portions. The steerable elongate instrument can then pass through the disengaged portion and extend into the pancreaticobiliary anatomy to perform the endoscopic procedure therein. The disengaged portion can be closed using the alterable gastric closure at the conclusion of the procedure.