EUS guided gastrojejunostomy: techniques and outcomes.

Abstract

Introduction: Surgical bypass, the traditional approach for managing gastric outlet obstruction (GOO), is effective but associated with increased morbidity and short-term complications. Enteral self-expanding metal stents (SEMS) provide a safe, effective, and minimally invasive alternative to surgical bypass, though they carry an increased risk of re-interventions due to stent blockage. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is a recently developed, novel minimally invasive procedure that serves as an alternative to enteral SEMS placement.

Areas covered: We performed an electronic search in PubMed and included all the types of articles on EUS-GJ written in English language till February 2025. This review discusses both the technical details and outcomes of EUS-GJ.

Expert opinion: EUS-GJ involves creating an anastomosis between the stomach and the small intestine using a lumen-apposing metal stent (LAMS). There are three basic techniques for performing EUS-GJ: the direct technique, the balloon-assisted technique, and the EPASS (EUS-guided double-balloon-occluded gastrojejunostomy bypass) technique. Among these, the free-hand direct approach is the most widely used due to its shorter procedure time and comparable technical outcomes to the other two techniques. Stent misdeployment is the most dreaded complication of EUS-GJ; however, fortunately, the majority of misdeployments can be successfully managed through rescue endoscopic methods.