{
  "abstract": "Introduction Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly favoured for the management of gastric outlet obstruction. Traditional EUS-GE techniques rely on enteral tube or balloon-assisted distension of the target small bowel loop distal to the obstruction. These additional steps can substantially increase procedural complexity and duration, particularly in sedation-led endoscopy units. In this two-centre UK study, we report outcomes using a direct needle-fill, wireless, radiation-free, EUS-guided technique, under conscious sedation, designed to simplify workflow and improve procedural efficiency.Methods Retrospective consecutive patients undergoing EUS-GE for gastric outlet obstruction were identified in two UK hepatopancreatobiliary centres between February 2023 and December 2025. All procedures were performed by three experienced operators using the direct needle-fill technique, under conscious sedation. This technique involves confirmatory needle access with intraluminal filling before electrocautery-enhanced lumen-apposing metal stent (LAMS) deployment, without the use of enteral access devices or fluoroscopy.Results Sixty-two patients were included, with an equal number of males and females and a mean age of 67 years. Indications included hepatopancreatobiliary malignancy (63%), gastric cancer (11%), duodenal cancer (8%), metastatic disease (11%), and benign disease (6%). A 20-mm LAMS was used in 87% of cases and a 15-mm LAMS in 13%. Mean procedure time, defined as the interval from scope insertion to scope withdrawal, was 15.6 minutes (SD 10.3). Initial technical success was achieved in 92% of procedures; following immediate endoscopic rescue, final technical success was 96.7%. Clinical success, assessed using the Gastric Outlet Obstruction Scoring System (GOOSS), demonstrated a mean improvement of 2.2 points, from 0.6 pre-procedure to 2.8 post-procedure. Six adverse events (10%) occurred within 24 hours, including one episode of bleeding and five cases of initial stent maldeployment. Three maldeployments were successfully rescued with immediate LAMS replacement at the index procedure. Seven deaths occurred within 30 days; only one was directly related to the procedure.Conclusion EUS-GE using the direct needle-fill technique demonstrates comparable efficacy and safety to other EUS-GE approaches while representing a significant step-change in procedural efficiency through workflow simplification. In expert centres, it may offer an efficient and scalable approach to EUS-GE, including delivery under conscious sedation.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK, Cambridge, United Kingdom"
      ],
      "name": "Vasileios Galanakis"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Birmingham University Hospitals NHS Foundation Trust, Birmingham, UK, Birmingham, United Kingdom"
      ],
      "name": "Colm Forde"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK, Cambridge, United Kingdom"
      ],
      "name": "Edmund Godfrey Godfrey"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Birmingham University Hospitals NHS Foundation Trust, Birmingham, UK, Birmingham, United Kingdom"
      ],
      "name": "Brinder Mahon"
    }
  ],
  "title": "P49 Endoscopic ultrasound-guided gastroenterostomy using a conscious sedation direct needle-fill technique: a two-centre UK experience",
  "uid": "b23d0548-2270-5e33-9902-7b20473346ca"
}