{
  "abstract": "Recent advances in the management of gastric outlet obstruction (GOO) have led to a paradigm shift from traditional duodenal stenting (DS) toward endoscopic ultrasound-guided gastrojejunostomy (EUS-GE). Multiple meta-analyses and multicentre studies have demonstrated that EUS-GE achieves higher clinical success rates, lower reintervention rates, and improved stent patency compared to DS, while maintaining comparable technical success and safety profiles. 1 3–5 The European Society of Gastrointestinal Endoscopy now recommends EUS-GE as an alternative to DS or surgical gastrojejunostomy in expert centres, reflecting its favourable outcomes in malignant GOO.1In this single (high volume, tertiary referral) centre retrospective analysis, we reviewed medical records of patients who underwent DS and/or EUS-GE from June 2019 to October 2025.71 patients underwent duodenal stenting (31 female/40 male), while 33 underwent EUS GJ (20 female/13 male). Median age of DS group 67 years old (range 32-91)vs EUS GJ group 66 years old (range 37-86). Median survival of DS cohort 100 days (range 6-604 days) vs median survival of EUS GJ cohort 86 days (range 9-516 days). Median survival of DS cohort 100 days (range 6-604 days) vs median survival of EUS GJ cohort 86 days (range 9-516 days). Re-intervention rate in DS group: 26.7% (19/71) vs reintervention rate of EUS GJ group: 6% (2/33). Median duration of DS procedure 31min (range 13-74min) vs median duration of EUS GJ procedure 49min (range 23-76min). Median time to resolution of GOO (defined as resumption of oral fluid/food consumption and absence of vomiting): 1 day in EUS GJ group (range 1-2 days) vs 1 day in DS group (range 1-7 days). Over the study period, the number of DS procedures has levelled off, while the number of EUS-GJ procedures has steadily risen year on year since 2022. This study adds to the growing body of evidence in support of EUS-GJ for patients with malignant GOO.References Teoh AYB, Lakhtakia S, Tarantino I, et al. Endoscopic ultrasonography-guided gastroenterostomy versus uncovered duodenal metal stenting for unresectable malignant gastric outlet obstruction (DRA-GOO): a multicentre randomised controlled trial. The Lancet. Gastroenterology & Hepatology. 2025;10(6):e8–e16. doi:10.1016/S2468-1253(25)00136-0.Ahmed O, Lee JH, Thompson CC, Faulx A. AGA clinical practice update on the optimal management of the malignant alimentary tract obstruction: expert review. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association. 2021;19(9):1780–1788. doi:10.1016/j.cgh.2021.03.046.Jain H, Dey D, Odat RM, et al. Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for gastric outlet obstruction: a systematic review, meta-analysis, and meta-regression. Medicine. 2024;103(40):e39948. doi:10.1097/MD.0000000000039948.van Wanrooij RLJ, Vanella G, Bronswijk M, et al. Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for malignant gastric outlet obstruction: an international, multicenter, propensity score-matched comparison. Endoscopy. 2022;54(11):1023–1031. doi:10.1055/a-1782-7568.Sánchez-Aldehuelo R, Subtil Iñigo JC, Martínez Moreno B, et al. EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study (with video). Gastrointestinal Endoscopy. 2022;96(6):1012–1020.e3. doi:10.1016/j.gie.2022.07.018.Bang JY, Puri R, Lakhtakia S, et al. Endoscopic or surgical gastroenterostomy for malignant gastric outlet obstruction: a randomised trial. Gut. 2025:gutjnl-2025-336339. doi:10.1136/gutjnl-2025-336339.Canakis A, Bomman S, Lee DU, et al. Benefits of EUS-guided gastroenterostomy over surgical gastrojejunostomy in the palliation of malignant gastric outlet obstruction: a large multicenter experience. Gastrointestinal Endoscopy. 2023;98(3):348–359.e30. doi:10.1016/j.gie.2023.03.022.Chan SM, Dhir V, Chan YYY, et al. Endoscopic ultrasound-guided balloon-occluded gastrojejunostomy bypass, duodenal stent or laparoscopic gastrojejunostomy for unresectable malignant gastric outlet obstruction. Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society. 2023;35(4):512–519. doi:10.1111/den.14472.",
  "authors": [
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "Alan Marrinan"
    },
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "Gavin Johnson"
    },
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "Danujan Sriranganathan"
    },
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "Lynn Affarah"
    },
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "Simon Phillpots"
    },
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "George Webster"
    },
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "Tareq El Menanawey"
    },
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "Stephen Pereira"
    },
    {
      "affiliations": [
        "University College Hospital London, London, United Kingdom"
      ],
      "name": "Michael Chapman"
    }
  ],
  "title": "P20 Evolution of gastric outlet obstruction management: insights from a UK tertiary centre",
  "uid": "edb898fd-1ee5-5ea3-9295-89b4f7b24aa0"
}