Comparison of a novel balloon-assisted EUS-GE versus direct EUS-GE: A multicenter retrospective study (with video)

Background and Objectives: Gastric outlet obstruction impedes gastric emptying into the duodenum. Although EUS-guided gastroenterostomy (EUS-GE) provides a minimally invasive therapeutic option, current techniques are limited by significant constraints. This study evaluated the safety and efficacy of direct EUS-GE (DGE) compared with a novel balloon-assisted EUS-GE (NBAGE). Methods: This multicenter retrospective cohort study enrolled patients who underwent EUS-GE in 4 high-volume tertiary Chinese referral centers from June 2023 to December 2025. Forty-six patients with DGE and 55 patients with NBAGE were included. Technical and clinical success rates, procedural time, adverse events, injection volume, postoperative length of stay, and mortality were compared. Results: Among 101 patients, NBAGE had significantly higher technical success as compared with DGE (100% vs. 87.0%, P = 0.007). Clinical success was similar between groups (95% vs. 96.4%, P = 1.0). The mean procedural time was similar between DGE and NBAGE (32 vs. 30.4 min, P = 0.564). Thirty-day adverse events occurred in 5 of 40 patients (12.5%) in the DGE group versus 1 of 55 patients (1.8%) in the NBAGE group ( P = 0.079). NBAGE required significantly less injection volume (101 vs. 647 mL, P < 0.001). Postoperative length of stay did not differ significantly (5 vs. 4 days, P = 0.124). The mortality rate was 0% in both groups. Conclusion: NBAGE was associated with significantly higher technical success with substantially reduced injection volume, providing a safe and effective alternative technique for EUS-GE.