EUS-guided gastroenterostomy is a safe and effective approach for benign and malignant gastric outlet obstruction in a EUS reference center

Aims Gastric outlet obstruction (GOO) is a clinical syndrome caused by benign and malignant mechanical obstruction. Balloon dilation, self-expandable metal stents (SEMS) and surgical gastroenterostomy are classical therapeutic options. The authors aim to assess the effectiveness and safety of EUS-guided gastroenterostomy (EUS-GE) for GOO.

Methods Case-series of EUS-GE performed by a single operator in a EUS high-volume/reference center. In all cases direct EUS-GE technique was applied: after 0.035´´guidewire placement through the proximal jejunum, a 7-french nasobiliary drain is inserted, allowing jejunal distension through saline/iodate contrast/methylene blue infusion. Using a linear echoendoscope through the gastric wall, a distended loop is identified and EUS-guided puncture with a 19G needle is performed, after which a lumen-apposing metal stent (20x10mm LAMS; Hot AXIOS) is deployed. Flow of blue mixture to the lumen confirms successful gastroenterostomy creation [1] [2] [3].

Results 11 patients (9 male/2 female; mean age 74 years) underwent EUS-GE due to GOO caused by pancreatic adenocarcinoma (n=5), gastric adenocarcinoma (n=3), ampulloma (n=1), urothelial cancer (n=1) and after surgery of a perforated ulcer (n=1) causing duodenal stenosis. Weight loss/food intolerance/postprandial vomiting were the main symptoms and upper endoscopy confirmed GOO diagnosis. In the benign GOO patient, two sessions of balloon dilation until 20mm were attempted with poor clinical/endoscopic improvement. Antibiotic prophylaxis was always performed. Technical success rate was 82% (9/11). In two patients, recurrent colon interposition and stent misdeployment in the duodenal bulb precluded the procedure. No other adverse events were observed. All patients were hospitalized overnight and resumed oral feeding the day after the procedure. No symptom recurrence was observed after 3-6 months follow-up.

Conclusions EUS-GE is a safe and effective minimally invasive technique for patients with benign or malignant GOO, without the surgical risks and the limited long-term efficacy of SEMS. High technical success, fewer adverse events and patient clinical improvement are expected in EUS reference centers.

Publication History

Article published online:
27 March 2025

• References

• 1 Miller C, Benchaya JA, Martel M. et al. EUS-guided gastroenterostomy vs. surgical gastrojejunostomy and enteral stenting for malignant gastric outlet obstruction: a meta-analysis. Endosc Int Open 2023; 11 (7): E660-E672
• 2 vanWanrooij RLJ, Bronswijk M, Kunda R. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2022; 54: 310-332
• 3 van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 185-205