Besides malignant, gastric outlet obstruction (GOO) may develop for differentbenign diseases, including post-inflammatory stenosis of distal stomach/duodenum or duodenalinvolvement in groove pancreatitis. A novel Ultrasound-guided gastroenteroanastomosis (EUS-GE)was introduced to allow creating a direct anastomosis between the stomach and a jejunal loopthrough the placement of a metal stent (LAMS). This procedure is currently suggested to solveGOO in patients unfit for surgery. Consistent data are available on EUS-GE in neoplastic GOO,whilst data are still limited for patients with benign GOO. We aim to assess technical and clinicaloutcomes of EUS-GE in benign GOO.

This was a retrospective study including patients with benign GOO treated with EUS-GEprocedure in 11 tertiary Endoscopy centers. Data about patients, procedure and outcomes wererecovered and collected in a single, anonymized database for analysis. Technical success wasdefined as the successful placement of a stent across the site of obstruction, and clinical success asat least 1 point increase in the gastric outlet obstruction score (GOOS) system.

A total of 31 (67.7% male; Median age: 69 yrs) patients were included. The mainindications for the EUS-GE procedure were: 13 (41.9%) post peptic/caustic inflammatory stenosis,9 (29%) groove/chronic pancreatitis, and 4 (12.9%) post-surgical stenosis, and 5 (16%) post morerare causes. In 19 (61.3%) patients, previous pneumatic dilations (N = 10) or stent placement (N =

9) were unsuccessfully attempted. EUS-GE was the first-line treatment of GOO 12 cases, more thanhalf (58.4%) of which were pancreatitis. Technical success of EUS-GE was achieved in 30 of 31(96.7%) patients in a median procedural time of 45 minutes (30-90). The only case of technicalfailure with stent misplacing has been solved with endoscopy. In 5 (16.6%) cases (3 bleeding and 2stent obstruction) endoscopy reintervention was needed within 30 days. In 2 cases clinicalresolution of GOO was not obtained requiring surgical intervention whereas in 93% of patients astable benefit was maintained after median follow-up of 4 months (1-18).

This report seems to suggest that the EUS-GE, when performed form skill operator, itis very effective procedure with an acceptable rate of complication manageable without surgery. Toextend the application of EUS-GEalso in benign chronic GOO, larger and prospective studies are need especially for what concern thelong-term management of LAMS.