It can be done with wrapping tuples, but it’s ugly. You have to do things like:

with {:ok, result} <- get_result(),
    {{:ok, other_result}, result} <-  {{get_other_result()}, result} do
  :success
else
  {_, result} -> IO.inspect(result)
end

If you find yourself in that situation, then it’s probably worth stepping back to look at the bigger picture for other design approaches.

But the basic fact is that those bindings available in the expressions and do block are no longer in scope during the else

Correct. I generally find having more than one clause in else an anti-pattern. We either use it as a “catch-all”, otherwise I prefer to have each function in with already return the proper types, as shown in your last example.