Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017

Gastric outlet obstruction (GOO) can be caused by benign and malignant diseases and often leads to a reduction in patient quality of life. Lately, endoscopic ultrasonography (EUS)-guided gastroenterostomy (EUS-GE) has emerged. At the present time, there are three types of EUS-GE using lumen-apposing biflanged metal stents (LAMS): (i) direct EUS-GE; (ii) assisted EUS-GE using retrieval/dilating balloon, single balloon overtube, nasobiliary drain and ultraslim endoscope; and (iii) EUS-guided double-balloon-occluded gastrojejunostomy bypass (EPASS). Overall technical success rate is approximately 90% regardless of technique used, although this is based on two retrospective studies only. In the EPASS procedure, the success rate of the one-step procedure was higher than that of the two-step procedure (100% vs 82%). Clinical success was almost uniform when stent placement was technically successful. Although there have been no-stent induced procedural deaths, adverse events were seen in several cases. One technically failed case carried out using balloon-assisted EUS-GE was converted to laparoscopic gastrojejunostomy. Two failed cases in EPASS procedure improved with conservative treatment. In the present review, we show the feasibility and outcomes using novel EUS-GE using LAMS. Clinical prospective trials with comparison to luminal enteral stents and surgical GE are warranted.