Correct identification of the Treitz flexure during EUS-guided gastroenterostomy (EUS-GE) is essential. Three anatomical variants have been described, with Type III (an inverted alpha-loop) being prone to misinterpretation between duodenal and jejunal limbs.  We reviewed 238 EUS-GE procedures from a prospective multicenter registry (GESICA, NCT-05128604) performed with oro-enteral catheter assistance. Only cases in supine position were analyzed to optimize angle assessment. Type III anatomy was found in 18% of procedures.These cases were examined, and an educational video integrating fluoroscopy and EUS images was developed to illustrate key recognition features. Awareness of Type III configuration may help anticipate technical challenges, prevent misidentification of the duodenojejunal flexure, and avoid unexpected difficulties in patients who may later require surgery.