Malignant gastric outlet obstruction (MGOO) is a significant complication of advanced malignancy, traditionally managed through surgical bypass or duodenal stenting. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) with lumen-apposing metal stents (LAMS) represents a minimally invasive alternative offering durable symptom palliation with lower morbidity than surgical approaches. Previous cohort studies have reported high technical and clinical success rates for EUS-GJ, but UK real-world data remain limited. 

We aimed to evaluate the feasibility, safety, and clinical efficacy of EUS-GJ with LAMS in a UK tertiary centre cohort, with particular focus on length of stay, time to oral intake, and objective dietary progression using the Gastric Outlet Obstruction Score (GOOS). 

A retrospective service evaluation was undertaken of 13 consecutive patients undergoing EUS-GJ for MGOO between January 2024 and September 2025. All procedures used a 20mm LAMS. Primary outcomes were technical success (successful stent deployment) and clinical success (improvement in GOOS). Secondary outcomes included post-procedure length of hospital stay, time to oral intake, and longitudinal GOOS-based assessment of diet (pre-procedure, 1 week, 1 month, and where available 3, 6, and 12 months).

The cohort comprised of 13 patients (median age 65 years, range 53–89 years; 10 males, 3 females). Underlying diagnoses were pancreatic cancer (10/13, 76.9%), distal cholangiocarcinoma (1/13, 7.7%), small bowel adenocarcinoma (1/13, 7.7%), and a single undiagnosed case. Most obstructions were in D2 (8/13) or the D1/D2 junction (2/13).  

Technical success was achieved in 12 of 13 cases (92.3%), with one case of stent maldeployment managed endoscopically and rescheduled for successful placement one week later. No patients required intervention for stent obstruction or malfunction after successful deployment.

Post-procedural complications occurred in 1 of 13 patients (7.7%): this involved a major post-procedural haemorrhage which was managed successfully - requiring ITU admission and blood transfusion only. No delayed complications requiring readmission were observed. 

Clinical success was high, with marked and sustained GOOS improvement. Baseline GOOS was G0-G1 (liquid or no oral intake). By 1-week post-procedure, 8/13 patients (61.5%) had reached G3 (tolerance of normal diet), and by one month, all 13 patients (100%) had achieved G3. There was rapid in-hospital progression from liquids to soft diet within a few days. Among patients with extended follow-up, 2 patients maintained G3 by 12 months, a further 2 maintained G3 at 6 months, and 3 maintained G3 at 3 months. There were no documented permanent regressions in GOOS scores. 

Length of post-procedural hospital stay varied with a median 7 days (IQR 12 days, range 0–39 days). Most patients (8/13) were discharged within one week of their procedure, with three patients requiring extended stays (>2 weeks) due to concurrent medical complications unrelated to stent placement.   

EUS-GJ with LAMS in a UK tertiary centre is feasible, safe, and highly effective in the palliative management of malignant gastric outlet obstruction. The technique demonstrates high technical success, rapid resumption of oral intake (liquids within 24 hours), and excellent clinical outcomes, with all patients achieving sustained G3 GOOS (normal diet) by one month. The complication profile is acceptable and manageable, and post-procedure length of stay is compatible with complex oncological care. EUS-GJ should be considered a key minimally invasive alternative to surgical bypass or duodenal stenting, and larger multicentre UK studies are warranted to further validate these findings.