Standardizing Success and Troubleshooting in EUS-Guided Gastroenterostomy
EUS-guided gastroenterostomy (EUS-GE) is rapidly emerging as a pivotal procedure in the management of gastric outlet obstruction due to its advantages over historical comparators such as surgical gastroenterostomy and endoscopic placement of gastroduodenal stents. The ability to create a stable surgical-range connection between 2 lumens, distant from the tumor, with the minimally invasive nature of an endoscopic procedure, offers high clinical efficacy, acceptable safety, and low recurrence rates. However, widespread adoption is impeded by the steep learning curve and lack of standardized methodologies. Like other interventional EUS procedures, EUS-GE utilizes lumen apposing metal stents. Unlike drainage procedures, the target in EUS-GE is a mobile structure with a virtual resting caliber that needs to be distended to create the connection, making misdeployment a significant drawback. This comprehensive illustrated technical review dissects the general and specific technical principles of EUS-GE covering the equipment, scene, settings, and endoscopic signs of correct and incorrect placement. It provides a deeper insight into the wireless simplified EUS-GE technique, the EUS-guided double-balloon-occluded gastrojejunostomy bypass, and the direct technique. Through pragmatic tips, expert advice, and elucidative step-by-step videos, a systematic roadmap for mastering this intricate procedure is presented. By addressing common challenges and providing troubleshooting strategies, this review aims to demystify EUS-GE, equipping practitioners with the tools to achieve reproducible and optimal outcomes.
Authors
- Marc Barthet (ORCID: https://orcid.org/0000-0001-6589-7160)
- Enrique Pérez‐Cuadrado‐Robles (ORCID: https://orcid.org/0000-0001-8254-7453)
- Shannon Melissa Chan (ORCID: https://orcid.org/0000-0001-6280-4176)
- Prabhleen Chahal (ORCID: https://orcid.org/0000-0002-4744-4288)
- Takao Itoi (ORCID: https://orcid.org/0000-0002-9433-8437)
- Pierre H. Deprez (ORCID: https://orcid.org/0000-0001-8926-8967)
- Michel Kahaleh (ORCID: https://orcid.org/0000-0003-0836-6114)
- Anthony Yuen Bun Teoh (ORCID: https://orcid.org/0000-0002-1885-8035)
- Rastislav Kunda (ORCID: https://orcid.org/0000-0001-5632-2402)
- Todd H. Baron (ORCID: https://orcid.org/0000-0003-4934-3090)
- Yen‐I Chen (ORCID: https://orcid.org/0000-0001-5704-2226)
- Manuel Pérez‐Miranda (ORCID: https://orcid.org/0000-0003-0744-220X)
- Giuseppe Vanella (ORCID: https://orcid.org/0000-0001-7280-1761)
- Francesco Frigo (ORCID: https://orcid.org/0000-0002-4503-4293)
- Van der Merwe (ORCID: https://orcid.org/0000-0002-9891-2686)
- Paolo Giorgio Arcidiacono (ORCID: https://orcid.org/0000-0001-6692-7720)
- Reem Z. Sharaiha (ORCID: https://orcid.org/0000-0002-3235-6904)
- Manol Jovani (ORCID: https://orcid.org/0000-0001-6803-8521)
- Michiel J. Bronswijk (ORCID: https://orcid.org/0000-0003-2039-5022)
- Amy Tyberg (ORCID: https://orcid.org/0000-0001-5760-8170)
- Mouen A. Khashab (ORCID: https://orcid.org/0000-0001-8913-6489)
- Roberto Leone (ORCID: https://orcid.org/0009-0005-7438-3221)
- Kenneth F. Binmoeller
- Douglas G. Adler
- Roy van Wanroij
Institutions
- University of North Carolina at Chapel Hill (US)
- Cliniques Universitaires Saint-Luc (BE)
- Maimonides Medical Center (US)
- NewYork–Presbyterian Hospital (US)
- Vrije Universiteit Brussel (BE)
- Vita-Salute San Raffaele University (IT)
- The University of Texas at San Antonio Health Science Center (US)
- Chinese University of Hong Kong (HK)
- Université Paris Cité (FR)
- Cornell University (US)
- Aix-Marseille Université (FR)
- Porter Adventist Hospital (US)
- Universitair Ziekenhuis Leuven (BE)
- New York Hospital Queens (US)
- McGill University Health Centre (CA)
- California Pacific Medical Center (US)
- Johnson University (US)
- Presbyterian Hospital (US)
- Baptist Health South Florida (US)
- Hôpital Européen Georges-Pompidou (FR)
- Tokyo Medical University Hospital (JP)
- Prince of Wales Hospital (CN)
- Hôpital Nord (FR)
- Universitair Ziekenhuis Brussel (BE)
- Imelda Hospital (BE)
- Asian Institute of Gastroenterology (IN)
- National University Hospital (SG)
- Hackensack Meridian Health (US)
- Johns Hopkins Hospital (US)
- Amsterdam University Medical Centers (NL)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Hospital Universitario Río Hortega (ES)
- KU Leuven (BE)
Publication Details
- Journal
- Journal of Clinical Gastroenterology
- Published
- 2025-09-18
- DOI
- https://doi.org/10.1097/mcg.0000000000002242
- Citations
- 3
- Primary Topic
- Esophageal and GI Pathology
- Type
- article
- Field-Weighted Citation Impact
- 6.02
Funders
- Boston Scientific Corporation