EUS Guided Gastrojejunostomy

Gastric outlet obstruction (GOO) is a common complication of pancreatic and upper gastrointestinal (GI) malignancies. The palliative treatment options have traditionally included surgical gastrojejunostomy and enteral stenting. Surgical gastrojejunostomy can be challenging in this group of patients who commonly harbour a poor operative state due to malnourishment which leads to prolonged recovery times and poor wound healing. Consequently, delays in commencement of chemotherapy may occur. Other adverse events related to surgical gastrojejunostomy include delayed gastric emptying, prolonged hospital stay and increased costs [1, 2]. Enteral stenting is less invasive than surgery, but is limited by stent occlusion due to tumor ingrowth, over growth or both with an average stent patency of 2-3 months. Hence, stenting is less durable than surgery and may require re-intervention [3, 4]. This has rendered surgical gastrojejunostomy preferable over enteral stenting at many institutions for patients with expected survival longer than 3-4 months [5].