Endoscopic ultrasound-guided gastroenterostomy is gaining traction as a less-invasive alternative to surgical bypass and enteral stenting for patients with gastric outlet obstruction.
The procedure uses endoscopic ultrasound to identify a loop of small intestine adjacent to the stomach. A lumen-apposing metal stent is then deployed to create a bypass channel, mimicking a surgical gastrojejunostomy without the need for surgery.
Meta-analyses have reported pooled technical success rates of about 92% and clinical success rates of 90%, with fewer adverse events than surgical gastrojejunostomy and lower recurrence rates compared with enteral stenting, according to a January 2025 review in Translational Gastroenterology and Hepatology.
“Endoscopic ultrasound has been used in the GI tract for many years, both diagnostically and therapeutically,” Jessica Widmer, DO, reviewer on the TGH study and chief of the division of gastroenterology at Mineola, N.Y.-based NYU Langone Hospital—Long Island told Becker’s.
Dr. Widmer described EUS-GE as a minimally invasive alternative to surgery that creates a new pathway around malignant gastric outlet obstructions. By using endoscopic ultrasound to guide the bypass, patients who once faced severe nausea, vomiting and an inability to eat can often resume oral intake much more quickly.
“Patients with gastroenterostomies can eat much faster — sometimes the same day or the very next day,” Dr. Widmer said.
She added that the procedure hinges on the development of LAMS.
“We really would not be able to do this procedure without lumen-apposing metal stents,” Dr. Widmer said. “Their design, with flanges that hold the stomach and bowel apposed, makes the connection stable and prevents stent migration.”
Beyond faster feeding and shorter hospital stays, she noted that EUS-GE can minimize delays in cancer treatment compared with surgical approaches, which are often associated with longer recovery and complications such as delayed gastric emptying.
Still, Dr. Widmer cautioned that the procedure remains technically complex.
“This is really one of the most complex therapeutic EUS techniques,” she said. “Because the bowel is mobile, placing the stent can be technically challenging. That’s why it’s mostly done at high-volume expert centers, where multidisciplinary teams — gastroenterologists, surgeons, oncologists — work together.”
Looking ahead, she expects the role of EUS-GE to expand as technology and training evolve.
“It’s certainly being done for benign disease, but the majority is really for malignant disease,” Dr. Widmer said. “As people feel more comfortable with the technique itself and adverse events are reduced, I think it will start being applied more broadly.”
