Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a minimally invasive alternative to surgery for patients with high gastrointestinal obstruction, most commonly resulting from malignant gastric outlet obstruction (GOO) [1]. Despite increasing adoption, high-quality real-world clinical data remain limited. The aim of this study was to assess the safety, technical success, and early clinical outcomes—including improvements in oral intake—among patients undergoing EUS-GE during the first two years of implementing this procedure at a tetiary center.

We performed a retrospective analysis of prospectively collected database of adult patients who underwent EUS-GE at a single tetiary center from December 2023 to November 2025. Baseline demographic characteristics, underlying disease and clinical indications were collected at admission. Procedural parameters included technical success, peri-procedural course and adverse events (AEs). AEs were classified and described according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon [2], based on severity and clinical impact. Follow-up evaluation included assessment of dietary progression, symptom relief and need for reintervention within the first 1–3 months after the procedure. 

A total of 21 patients (11 male, 10 female; median age 67 years, range 41 - 86) were included. The majority (16/ 21, 76%) presented with malignant gastric outlet obstruction secondary to locally advanced pancreatic cancer, duodenal infiltration, or pyloric involvement. The remaining 5 patients (24%) underwent EUS-GE for nonmalignant indications, including chronic groove pancreatitis (1 case) or choledocholithiasis in patients after gastrectomy or surgical hepaticojejunostomy: endoscopic ultrasound-directed transgastric ERCP (EDGE) stage I – 2 cases and endoscopic ultrasound-directed transenteric ERCP (EDEE) stage I – 2 cases. The median procedure duration was 38 minutes (range 26 - 71), with no significant reduction in procedure time observed over the study period. Lumen-apposing metal stents (LAMS) were used in all procedures: 16×30 mm stents in 2 cases (9,5%) and 20×10 mm in 19 cases (90,5%).

Technical success was achieved in 20/21(95%) procedures. One case (5%) of failed bowel loop puncture occurred, followed by laparotomy 10 days later due to untreated gastric outlet obstruction. The only perforation which occurred after an initially successful EUS-GE, was noted during the first year of performing the procedure and was successfully treated surgically. 

Within 8 days after the procedure, two patients (9,5%) died due to progression of advanced malignant disease, not as a procedure-related adverse event. 1 patient (5%) was lost to follow-up. 

Remarkably, all patients undergoing EUS-GE for malignant GOO demonstrated a rapid improvement in oral intake, progressing from pre-procedural intolerance of liquids or solids to the ability to tolerate a soft or full oral diet shortly after the intervention. During the 1-month follow-up, no reinterventions or stent-related complications were observed. Throughout the entire follow-up period (median 35 days, range 7-90 days), one case of ulceration at the stent site (1.5 months post-procedure) and one case of recurrent obstructive symptoms (> 30 days post-procedure) were documented.

The single center retrospective analysis of prospectively collected patient database demonstrates that EUS-GE provides high technical and clinical success rate and a quite favorable safety profile even early in the learning curve. The procedure resulted in rapid and meaningful clinical improvement, reflected by restoration of oral intake and relief of obstructive symptoms. In patients with malignant gastric outlet obstruction—who typically have limited therapeutic options and poor performance status—EUS-GE appears to be an effective, reproducible and minimally invasive alternative to surgical gastroenterostomy. These results strongly support broader adoption of EUS-GE as a frontline therapeutic strategy in appropriately selected patients.