Relief of Gastric Outlet Obstruction: Is Endoscopy Treatment Better Than Surgery?

Relief of Gastric Outlet Obstruction: Is Endoscopy Treatment Better Than Surgery?

Vanessa M. Shami, MD, FASGE, reviewing Canakis A, et al. Gastrointest Endosc 2023 Mar 31.

Malignant gastric outlet obstruction (mGOO) results in significant morbidity and decreased quality of life. Treatment options include surgical gastrojejunostomy (SGJ) and endoscopic ultrasound-guided gastroenterostomy (EUS-GE). This retrospective multicenter study aimed to compare the two treatment modalities by examining primary outcomes: oral intake resumption, length of stay (LOS), and mortality. Secondary outcomes were technical and clinical success, reintervention rates, adverse events (AEs), and resumption of chemotherapy. 

The study included 310 patients (187 underwent EUS-GE, and 123 received SGJ [77 open and 46 laparoscopic]). Compared with patients who underwent SGJ, patients who received EUS-GE were able to resume oral intake sooner (1.40 vs 4.06 days; P<.001) and had a shorter LOS (5.31 vs 8.54; P<.001). However, there was no difference in mortality (48.1% vs 50.4%; P=.78) between both palliative techniques. 

The EUS-GE and SGJ groups, respectively, had similar technical success rates (97.9% and 100%) and clinical success rates (94.1% vs. 94.3%). The reintervention rate was higher after EUS-GE than SGJ (15.5% vs 1.63%; P<.001), and patients who underwent EUS-GE resumed chemotherapy significantly sooner (16.6 vs 37.8 days; P<.001). Additionally, the interval time to resumption of oral intake was much shorter with EUS-GE than SGJ (1.4 vs 4.06 days; P<.001), and the adverse event rate was lower (13.4% vs 33.3%; P<.001).

Vanessa M. Shami, MD, FASGE


Although EUS-GE appears to be a good option for the palliation of mGOO, the procedure is technically challenging and should be performed by expert interventional endoscopists. Prospective, randomized trials are needed to compare outcomes of EUS-GE versus SGJ in patients with mGOO.


Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


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. Gastrointest Endosc 2023 Mar 31. (Epub ahead of print) (

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