Endoscopic ultrasound directed gastroenterostomy

Gastric outlet obstruction (GOO) is typically caused by intrinsic or extrinsic obstruction of the pyloric channel or duodenum. Surgical approaches to bypassing the obstruction have been the mainstay of therapy, though recent developments in endoscopy have allowed for a minimally invasive approach to managing GOO. The development of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) represents a major advancement in the management of GOO. EUS-GE involves placement of a covered self-expandable metal stent into either the third or fourth portion of the duodenum to create a gastroduodenostomy or into the jejunum to create a gastrojejunostomy. In this review, we will discuss the different approaches to EUS-GE and the indications for each approach including direct EUS-GE, EUS-guided balloon-occluded GE, assisted EUS-GE, and contrast-enhanced EUS-GE.