Endoscopic Ultrasound最新文献

{"title":"Gaps and insights toward evidence-based management for acute cholecystitis patients at high surgical risk.","authors":"Qianling Shi, Ping Yue, Meihua Wu, Jie Zhang, Bingyi Wang, Baoping Zhang, Chongfei Huang, Janne Estill, Yaolong Chen, Wenbo Meng","doi":"10.1097/eus.0000000000000204","DOIUrl":"10.1097/eus.0000000000000204","url":null,"abstract":"<p><p>Acute cholecystitis (AC) is one of the most common causes of emergency admission to surgical wards. Since 2007, the Tokyo guidelines have provided valuable insights into severity assessment and paved the way for clinical trials of tailored treatments. Although laparoscopic cholecystectomy is widely regarded as the standard and most frequently performed procedure, the optimal management of AC patients at high surgical risk due to significant comorbidities or advanced age remains a largely neglected challenge. Many existing studies have failed in their aim to optimize the management. In this review, we highlight 5 underrecognized problems in practice: limited evidence base due to lack of prospective research; inconsistent definitions of high surgical risk; the technical \"black box\" related to gallbladder drainage; limited consideration of patients' values and preferences; and the complexity of managing individuals from special populations. We discuss each of these 5 gaps thoroughly, referring to examples, and propose approaches to overcome these limitations. Our review thus offers new perspectives on standardized management strategies and promote the development of trustworthy guidelines for AC management in patients at high surgical risk. Efforts are particularly needed to conduct more prospective real-world research, standardize the definitions, and enhance communication between patients and healthcare professionals.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 4","pages":"253-265"},"PeriodicalIF":4.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing a single-cell RNA sequencing workflow using EUS-guided fine-needle aspiration for pancreatic ductal adenocarcinoma.","authors":"Yao Zhang, Xiangyi He, Xinchen Lu, Zonghao Liu, Tingting Gong, Tianyu Zhang, Lei Liu, Ling Zhang, Minmin Zhang, Chunhua Zhou, Duowu Zou","doi":"10.1097/eus.0000000000000214","DOIUrl":"10.1097/eus.0000000000000214","url":null,"abstract":"<p><strong>Background and objectives: </strong>No unified consensus exists regarding standardized protocols for single-cell RNA sequencing (scRNA-seq) analysis of samples obtained <i>via</i> EUS-guided fine-needle aspiration (EUS-FNA). This study aimed to evaluate the feasibility of applying scRNA-seq to EUS-FNA-derived pancreatic ductal adenocarcinoma (PDAC) samples and to compare their quality metrics and cellular composition with those of surgical resection-derived samples.</p><p><strong>Methods: </strong>PDAC samples obtained <i>via</i> EUS-FNA were subjected to scRNA-seq using the 10× Genomics platform. These data were integrated with publicly available PDAC scRNA-seq datasets derived from EUS-FNA and surgical resection samples. Quality-control metrics, doublet estimates, ambient RNA contamination scores, and cell-type composition were compared between sampling methods.</p><p><strong>Results: </strong>Compared with surgical resection-derived samples, EUS-FNA-derived samples showed lower transcript abundance and lower mitochondrial transcript percentages, while exhibiting comparable detected gene numbers, estimated doublet proportions, and ambient RNA contamination scores. These findings suggest that EUS-FNA-derived samples can generate analyzable single-cell transcriptomic profiles under the workflow used in this study. Differences in recovered cell-type composition were observed between sampling methods: EUS-FNA-derived samples showed relatively higher proportions of immune cells, whereas surgical resection-derived samples showed relatively higher recovery of several nonimmune cell populations. These differences may reflect both biological characteristics and sampling-related technical effects.</p><p><strong>Conclusions: </strong>This study supports the feasibility of scRNA-seq analysis using EUS-FNA-derived PDAC samples and suggests that EUS-FNA and surgical resection samples may provide complementary information. Further validation in larger, preferably paired prospective cohorts is warranted.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 4","pages":"310-317"},"PeriodicalIF":4.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of EUS through-the-needle microforceps biopsy sampling in pancreatic cystic lesions: The MOBIDYC trial-A prospective multicenter study (with video).","authors":"Elena Santos-Perez, Bertrand Napoleon, Fabrice Caillol, Jean Philippe Ratone, Jérôme Rivory, Florian Rostain, Romain Legros, Emmanuel Coron, Diane Lorenzo, Frédéric Prat, Cécile Gomercic, Stéphane Koch, Mohamed Gasmi, Julien Jezequel, Franck Cholet, Arthur Laquiere, Jérémie Jacques, Mathieu Pioche, Marc Giovannini, Marc Barthet, Geoffroy Vanbiervliet","doi":"10.1097/eus.0000000000000212","DOIUrl":"10.1097/eus.0000000000000212","url":null,"abstract":"<p><strong>Background and objectives: </strong>Accurate diagnosis of pancreatic cystic lesions (PCLs) is essential, as some have malignant potential while others are benign. EUS through-the-needle biopsy (EUS-TTNB) using Moray microforceps has emerged as a promising technique for obtaining cyst wall histology, though prospective multicenter data are lacking.</p><p><strong>Methods: </strong>We conducted a nationwide, prospective, multicenter study including 93 patients with PCLs ≥20 mm requiring histological diagnosis after initial imaging work-up. The primary outcome was the histological performance of EUS-TTNB. Secondary outcomes included technical success, predictors of histological performance, safety, and concordance with the gold standard.</p><p><strong>Results: </strong>EUS-TTNB provided adequate histological specimens in 72% of cases, with a 100% technical success rate. Predictive factors for histological performance included proximal location of the PCL (<i>P</i> = 0.027), absence of tissue component (<i>P</i> = 0.044), and no main pancreatic duct dilation (<i>P</i> = 0.025). Adverse events occurred in 17.2% of cases, 12 classified as AGREE I (limited and contained intracystic bleeding <i>n</i> = 10, pain <i>n</i> = 2), 3 AGREE II (bacteremia <i>n</i> = 1, mild acute pancreatitis <i>n</i> = 2), and 1 fatal AGREE V (hemoperitoneum and death of the patient). The concordance with the gold standard for EUS-TTNB (94.7%) was significantly higher than EUS morphology (<i>P</i> = 0.001) and intracystic CEA (<i>P</i> = 0.001). Twenty-five patients finally underwent surgery, and histological concordance with surgical specimens was 92%.</p><p><strong>Conclusion: </strong>EUS-TTNB is a valuable tool for diagnosing indeterminate PCLs, with superior performance compared with standard techniques. However, given the risk of adverse events, its use should be reserved for selected cases, especially in high-risk surgical patients.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 4","pages":"293-300"},"PeriodicalIF":4.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of macroscopic on-site evaluation in EUS-guided tissue acquisition for autoimmune pancreatitis: A retrospective study.","authors":"Takuya Doi, Hirotoshi Ishiwatari, Junya Sato, Akihiro Ohba, Hiroki Sakamoto, Masahiro Yamamura, Nobuyuki Ohike, Tomoko Norose, Yuko Kakuda, Masao Yoshida, Noboru Kawata, Kazunori Takada, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hiroyuki Ono","doi":"10.1097/eus.0000000000000225","DOIUrl":"10.1097/eus.0000000000000225","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pathological diagnosis of autoimmune pancreatitis (AIP) is essential for selecting the appropriate treatment strategy. Although macroscopic on-site evaluation (MOSE) can reduce the number of needle passes during EUS-guided tissue acquisition (EUS-TA) in pancreatic neoplasms, its utility in AIP remains unclarified. We investigated the utility of MOSE in diagnosing AIP using EUS-TA-derived specimens.</p><p><strong>Methods: </strong>We conducted a retrospective study of patients with type 1 AIP who underwent EUS-TA using fine-needle biopsy needles. Macroscopic visible core (MVC) length was measured using MOSE, and histological diagnosis was evaluated following the International Consensus Diagnostic Criteria. The correlation between MVC length and diagnostic yield, histological features, and tissue volume was assessed.</p><p><strong>Results: </strong>Thirty-eight lesions of 36 patients were included. Among these, 32 had definite AIP and four had probable AIP. Level 1 and 1 or 2 histologies were identified in 47% and 90% of lesions, respectively. Longer MVC length was associated with a higher level 1 histology detection rate (<i>P</i> < 0.01), with 22 mm as the optimal cutoff (area under the curve = 0.80; 95% confidence interval = 0.65-0.95). Specimens with MVC ≥22 mm (75%) had a significantly higher level 1 histology detection rate than those with MVC <22 mm (17%) (<i>P</i> < 0.001). MVC length positively correlated with tissue area (<i>r</i> = 0.789, <i>P</i> < 0.001) and independently affected level 1 histology detection (odds ratio = 11.2, <i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>MVC length ≥22 mm is a practical indicator of adequate tissue quality for the histological diagnosis of AIP. Therefore, MOSE may help determine the number of needle passes during EUS-TA in patients with AIP.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 4","pages":"301-309"},"PeriodicalIF":4.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged EUS-guided gastroenterostomy for malignant gastric outlet obstruction.","authors":"Xiangyang Wang, Hui Chen, Peng Liu, Ya Peng","doi":"10.1097/eus.0000000000000223","DOIUrl":"10.1097/eus.0000000000000223","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 4","pages":"335-337"},"PeriodicalIF":4.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS-guided neurolysis as a translational approach to tumor-promoting innervation in pancreatic cancer.","authors":"Christoph F Dietrich, Siyu Sun, Nan Ge","doi":"10.1097/eus.0000000000000226","DOIUrl":"10.1097/eus.0000000000000226","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 4","pages":"251-252"},"PeriodicalIF":4.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of pancreatic neuroendocrine tumor grading using an artificial intelligence-based video analysis model (GradAINet) applied to contrast-enhanced EUS videos.","authors":"Matteo Tacelli, Adrien Meyer, Gaetano Lauri, Armine Vardazaryan, Paolo Biamonte, Bastien Andlauer, Rubino Nunziata, Gabriele Capurso, Leonardo Sosa-Valencia, Nicolas Padoy, Paolo Giorgio Arcidiacono","doi":"10.1097/eus.0000000000000190","DOIUrl":"10.1097/eus.0000000000000190","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pancreatic neuroendocrine neoplasms (PNENs) are rare tumors with heterogeneous outcomes. Tumor grading (G), based on mitotic count and Ki-67 index, is the main prognostic factor guiding treatment. EUS-guided fine-needle aspiration/biopsy is the current standard but shows a misgrading rate up to 25%. We evaluated an artificial intelligence-based video analysis model to predict PNEN grading from contrast-enhanced EUS (CE-EUS) recordings.</p><p><strong>Methods: </strong>This retrospective study was conducted at Istituti di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, a European Neuroendocrine Tumor Society Center of Excellence. Patients were eligible if CE-EUS videos ≥1 minute (arterial and venous phases) and cyto-histological confirmation of PNEN were available. Exclusion criteria included mixed neuroendocrine-non-neuroendocrine neoplasms, missing Ki-67 grading, or poor video quality. CE-EUS videos were processed with a deep-learning video transformer model (GradAINet). The dataset was split into training (70%), validation (10%), and testing (20%) cohorts. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and F1-score.</p><p><strong>Results: </strong>Between 2022 and 2024, 115 patients were included (49 female, 42.6%): 70 had G1, and 45 had G2-G3 tumors. Overall, 253,751 video frames were analyzed. GradAINet achieved a sensitivity of 0.817 (95% confidence interval [CI]: 0.556-1.000), specificity 0.806 (95% CI: 0.588-1.000), positive predictive value 0.759 (95% CI: 0.500-1.000), negative predictive value 0.856 (95% CI: 0.667-1.000), and accuracy 0.811 (95% CI: 0.654-0.962).</p><p><strong>Conclusion: </strong>This artificial intelligence-driven CE-EUS video model shows high accuracy for PNEN grading and potentially complements EUS-guided fine-needle aspiration/biopsy. As the first video-based rather than static-image model, it represents a methodological advance. Multicenter validation on larger cohorts is needed before clinical implementation.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 3","pages":"210-216"},"PeriodicalIF":4.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS-guided gastroenterostomy <i>versus</i> enteral stent placement for malignant gastric outlet obstruction: A reconstructed individual patient data meta-analysis with meta-regression.","authors":"Mohammad Al Hayek, Marco Spadaccini, Ammar Fahaid, Mouen Khashab, Alberto Larghi, Antonio Facciorusso, Osamah Al Hayek, Muhammed Elhadi, John J Vargo, Douglas G Adler, Cesare Hassan","doi":"10.1097/eus.0000000000000205","DOIUrl":"10.1097/eus.0000000000000205","url":null,"abstract":"<p><p>Malignant gastric outlet obstruction is a frequent complication of advanced pancreatic and gastric antral malignancies requiring palliative intervention. EUS-guided gastroenterostomy (EUS-GE) has emerged as an alternative to enteral stent placement (ESP), but comparative evidence remains limited. We conducted a pairwise and reconstructed individual patient data meta-analysis of randomized controlled trials and cohort studies comparing EUS-GE with duodenal stent placement in adults with malignant gastric outlet obstruction. Systematic searches of PubMed, Web of Science, Scopus, and the Cochrane Library were performed from inception through November 15, 2025. Stent-related failure was the primary outcome and was analyzed as a time-to-event endpoint using reconstructed individual patient data from published Kaplan-Meier curves. Secondary outcomes included technical success, clinical success, overall survival, length of hospital stay, and adverse events. Random-effects models were applied using hazard ratios and risk ratios (RRs) with 95% confidence intervals (CIs). Ten studies comprising 1359 patients were included. EUS-GE was associated with a significantly lower rate of stent-related failure compared with duodenal stenting (hazard ratio, 0.57; 95% CI, 0.45-0.73; <i>P</i> < 0.001). Technical success was slightly lower with EUS-GE (RR, 0.98; 95% CI, 0.97-1.00; <i>P</i> = 0.028), whereas clinical success was significantly higher than ESP (RR, 1.13; 95% CI, 1.08-1.19; <i>P</i> < 0.001). Overall survival, length of hospital stay, and rates of adverse events were comparable between groups. EUS-GE was associated with lower stent-related failure rates and higher clinical success compared with enteral stenting, with similar survival and safety outcomes. Despite slightly lower technical success rates, EUS-GE remains a durable palliative option in experienced centers, while ESP remains appropriate for short-term palliation.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 3","pages":"181-190"},"PeriodicalIF":4.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of archived EUS-guided fine-needle biopsy samples for next-generation sequencing in pancreatic adenocarcinoma.","authors":"Rodrigo Mata, Piero Alberti, David García-Illescas, Susana Aguilar, Florian Castet, Carles Fabregat-Franco, Sharela Vega, Miquel Masachs, Monder Abu-Suboh, Laia Blanco, Roger Bel, Carmela Iglesias, Jordi Temprana Salvador, Maria Teresa Salcedo, Tian Tian, Ana Vivancos, Teresa Macarulla, Elizabeth Pando","doi":"10.1097/eus.0000000000000197","DOIUrl":"10.1097/eus.0000000000000197","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy with limited treatment options. Comprehensive molecular profiling with next-generation sequencing (NGS) may enable personalized therapies, but its feasibility using EUS-guided fine-needle biopsy (EUS-guided FNB) and broad panels in routine practice remains unclear. This study aimed to assess the feasibility of NGS using residual diagnostic tissue from EUS-guided FNB in PDAC, without dedicated sampling.</p><p><strong>Methods: </strong>We performed a retrospective single-center study of patients with PDAC who underwent EUS-guided FNB, analyzing residual paraffin-embedded tissue blocks for NGS using a 63-gene panel. Samples required a minimum tumor cellularity of 20% and tumor area ≥10 mm². Baseline, procedural, and genomic data were compared between NGS-feasible and NGS-unfeasible groups. The primary endpoint was technical success.</p><p><strong>Results: </strong>Thirty-five patients were included. NGS was successful in 74.3% of cases (26/35) using residual diagnostic material without additional biopsy passes. No significant baseline or procedural differences were observed between groups, except for metastatic disease, which was more frequent in the NGS-unfeasible group (55.6% <i>vs</i>. 11.5%, <i>P</i> = 0.029). KRAS mutations were identified in 73.1% of sequenced cases, predominantly at codon 12.</p><p><strong>Conclusion: </strong>EUS-guided FNB samples can support NGS from residual diagnostic tissue with high feasibility, avoiding dedicated sampling. This pragmatic approach may streamline molecular profiling and expand access to precision oncology in PDAC.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 3","pages":"225-230"},"PeriodicalIF":4.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superiority of long-term outcomes of EUS-guided gastroenterostomy over endoscopic stenting for the palliation of malignant gastric outlet obstruction: A prospective cohort study.","authors":"Yu-Ting Kuo, Sheng-Jie Chang, Hung-Yao Lin, Tung-Yen Lin, Weng Fai Wong, Ming-Lun Han, Chieh-Chang Chen, Shih-Hung Yang, Hsiu-Po Wang","doi":"10.1097/eus.0000000000000196","DOIUrl":"10.1097/eus.0000000000000196","url":null,"abstract":"<p><strong>Background and objectives: </strong>Limited prospective data exist comparing long-term outcomes of endoscopic placement of a self-expandable metallic stent (ES) and EUS-guided gastroenterostomy (EUS-GE) for unresectable malignant gastric outlet obstruction (mGOO). This large-scale study aimed to prospectively compare these 2 procedures with long-term follow-up.</p><p><strong>Methods: </strong>This single-center, prospective study enrolled 152 consecutive patients with unresectable mGOO who underwent ES (<i>n</i> = 76) or EUS-GE (<i>n</i> = 76) between August 2021 and January 2024, with follow-up until death or administrative censoring on January 31, 2025. The primary outcome was the reintervention rate, while secondary outcomes included technical and clinical success, changes in the gastric outlet obstruction score (GOOS), adverse events (AEs), and survival. A Cox regression model identified factors associated with reintervention and survival.</p><p><strong>Results: </strong>Both groups had comparable technical and clinical success rates and AEs. After a median follow-up of 121 days (interquartile range, 55-285), the EUS-GE group had a significantly lower reintervention (adjusted hazard ratio, 0.22, <i>P</i> < 0.001), longer stent patency (median, 566 days <i>vs</i>. 195 days; <i>P</i> < 0.001), and greater GOOS improvement (median, 3 <i>vs</i>. 2; <i>P</i> < 0.001) compared with the ES group. Poor performance status, the presence of ascites, and lack of chemotherapy were independent mortality risk factors.</p><p><strong>Conclusion: </strong>Compared with ES, EUS-GE provides longer stent patency, fewer reinterventions, and better relief of GOO symptoms while maintaining a similar safety profile. In an expert setting, EUS-GE should be considered the optimal approach for managing unresectable mGOO, as it offers superior short- and long-term outcomes.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"15 3","pages":"202-209"},"PeriodicalIF":4.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}