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CC BY 4.0 · Endosc Int Open 2026; 14: a27604544
DOI: 10.1055/a-2760-4544
Original article

Endoscopic ultrasonography-guided gastroenterostomy for malignant gastric outlet obstruction: Comparison between gastric and duodenal obstruction

Authors

  • Yorick L. van de Pavert 

    1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands (Ringgold ID: RIN8124)

  • Maronne I.D. Pheifer

    1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands (Ringgold ID: RIN8124)

  • Louise W.H. van Leeuwen

    1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands (Ringgold ID: RIN8124)

  • Rina Bijlsma

    2   Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, the Netherlands (Ringgold ID: RIN61363)

  • Marco Bruno

    3   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands (Ringgold ID: RIN6993)

  • Hendrik M. van Dullemen

    4   Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands (Ringgold ID: RIN10173)

  • Paul Fockens

    5   Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands (Ringgold ID: RIN26066)
    6   Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands

  • Akin Inderson

    7   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands (Ringgold ID: RIN4501)

  • Willem J. Lammers

    3   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands (Ringgold ID: RIN6993)

  • Niels G. Venneman

    8   Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, the Netherlands (Ringgold ID: RIN3231)

  • Rogier P. Voermans 

    5   Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands (Ringgold ID: RIN26066)
    6   Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands

  • Roy L.J. van Wanrooij

    9   Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, the Netherlands (Ringgold ID: RIN1209)
    6   Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands

  • Thomas R. de Wijkerslooth

    10   Department of Gastrointestinal Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (Ringgold ID: RIN1228)

  • Leon M.G. Moons

    1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands (Ringgold ID: RIN8124)

  • Frank P. Vleggaar

    1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands (Ringgold ID: RIN8124)
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Abstract

Background and study aims

It is currently unclear whether obstruction location affects clinical and procedure outcomes after endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) in patients with malignant gastric outlet obstruction (GOO). Therefore, we compared clinical outcomes of EUS-GE for malignant GOO located in the stomach with obstruction located in the duodenum.

Patients and methods

In this nationwide, multicenter, retrospective study, we included consecutive patients who underwent EUS-GE as palliative treatment for malignant GOO. Main outcomes were clinical success, serious adverse events (SAEs) recurrence of obstructive symptoms, and LAMS dysfunction.

Results

Between 2018 and 2023, 298 patients underwent EUS-GE. Clinical success was achieved in 73 of 82 patients with a gastric obstruction (94%) and in 174 of 216 patients with a duodenal obstruction (87%). No association was found between location of obstruction and clinical success (odds ratio [OR] 2.62, 95% confidence interval [CI] 0.91 to 7.52, P = 0.073) or SAEs (OR 0.26, 95% CI 0.06 to 1.20, P = 0.083). Recurrent obstructive symptoms occurred more frequently in patients with a gastric obstruction (hazard ratio 1.74, 95% CI 1.09 to 2.77, P = 0.020). LAMS dysfunction did not differ between the groups (7 patients [9%] with a gastric obstruction and 11 patients [5%] with a duodenal obstruction).

Conclusions

In this study, EUS-GE in patients with a gastric obstruction had comparable technical and clinical efficacy and a similar safety profile to EUS-GE for duodenal obstruction. However, gastric obstruction was associated with recurrent symptoms of obstruction unrelated to LAMS dysfunction.

Keywords

Endoscopic ultrasonography - Gastric cancer - Pancreas - Intervention EUS

Supplementary Material



Publication History

Received: 28 July 2025

Accepted after revision: 12 November 2025

Article published online:
02 February 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Yorick L. van de Pavert, Maronne I.D. Pheifer, Louise W.H. van Leeuwen, Rina Bijlsma, Marco Bruno, Hendrik M. van Dullemen, Paul Fockens, Akin Inderson, Willem J. Lammers, Niels G. Venneman, Rogier P. Voermans, Roy L.J. van Wanrooij, Thomas R. de Wijkerslooth, Leon M.G. Moons, Frank P. Vleggaar. Endoscopic ultrasonography-guided gastroenterostomy for malignant gastric outlet obstruction: Comparison between gastric and duodenal obstruction. Endosc Int Open 2026; 14: a27604544.
DOI: 10.1055/a-2760-4544
 

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