Endoscopic Ultrasound (EUS)-Guided Gastroenterostomy (EUS-GE)

Gastric outlet obstruction (GOO) can occur from both benign and malignant causes. Prior to identification of H. pylori and the advent of proton pump inhibitors, the most common cause of GOO was peptic ulcer disease. In recent decades, malignant GOO has become more common, often secondary to pancreatic adenocarcinoma. Historically, surgical gastrojejunostomy was considered the standard of care for patients with GOO and good functional status, regardless of etiology. Endoscopic placement of luminal self-expandable metal stents (SEMS) is efficacious and minimally invasive, and remains a widely accepted alternative to surgery for the treatment for malignant GOO. Luminal SEMS are rarely placed for benign disease. The suboptimal patency duration of luminal SEMS due to tumor ingrowth/overgrowth remains a significant limitation. Recently, endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) has evolved as a viable alternative to be considered for both malignant and benign etiologies, with early data demonstrating high technical and clinical success, with acceptable adverse event rates. Various iterations of EUS-GE techniques have been described, each with inherent advantages and select clinical scenarios where they can be applied.