*4.3.3 Transoral endoscopic membranotomy and balloon dilation*

The procedure is performed under general endotracheal anesthesia using a single-channel video gastroscope with a 3.2-mm instrument channel. Before the operation, the remnants of formula and saliva are removed from the stomach with irrigation and aspiration. After passing the pylorus, a dilated superior (first) segment of the duodenum is visualized blindly ending in a membrane with an opening is its center (**Figure 22**). When using the method of balloon dilation, a CRE Fixed Wire balloon catheter (Boston Scientific Corporation, USA), diameter of 10–11-12 mm and inflation pressure of 3–5-8 atm, is inserted into the opening of the duodenal membrane (**Figures 23** and **24**). After dilation of the lumen, the endoscope is advanced to the distal portion of the duodenum. Endoscopic
