Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative to surgical gastrojejunostomy or enteral stenting for the management of malignant gastric outlet obstruction (GOO). This multicenter study aimed to evaluate the outcomes of EUS-GE as a first-line treatment for both malignant and selected benign GOO

We retrospectively analyzed all patients who underwent EUS-GE as a primary treatment between November 2021 and October 2025 across five european referral centers. Primary outcomes were technical success, defined as correct stent placement, and clinical success, defined as improvement in the Gastric Outlet Obstruction Symptom Score (GOOSS ≥2). Secondary outcomes included adverse event rates, symptom recurrence, and the need for reintervention.

Forty-two patients were included (mean age 71,3 years, range 36-90; 61.9% male). The main etiologies were pancreatic cancer (16/42, 38.1%), gastric or duodenal cancer (12/42, 28.6%), and benign disease (7/42, 16.7%); carcinomatosis was present in 11 patients (26.2%). A 20x10 mm lumen apposing metal stent (LAMS) was used in 34/42 (80.9%) of the cases. Technical success was achieved in 37/42 (88.1%) cases, and clinical success in 39/42 (92.9%): in two cases, distal flange maldeployment occurred but was corrected during the same session. Adverse events were reported in 5/42 (11.9%) patients, primarily due to stent misdeployment, including two surgical intervention and one procedure-related death. During a mean follow-up of 163.7 days (range 15-510), symptom recurrence requiring endoscopic reintervention occurred in one patient (2.4%).

EUS-GE demonstrated high technical and clinical success rates with low adverse event and reintervention rates. Nonetheless, the potential for severe complications underscores the need for careful patient selection and experienced operators. Overall, these findings support EUS-GE as an effective first-line treatment option for malignant and selected benign gastric outlet obstruction