To review the changing trends of endoscopic management of Gastric Outlet Obstruction (GOO) in a large tertiary referral centre in the UK, comparing the outcomes of patients undergoing Duodenal Stenting vs Endoscopic Ultrasound-Guided Gastro-Jejunostomy 

We conducted a single centre retrospective analysis reviewing all patients referred for management of GOO between June 2019 and October 2025. Over 300 Electronic Medical Records (EMR) of cases discussed at our MDT were reviewed to select patients subsequently managed with Duodenal Stenting (DS) and/or Endoscopic Ultrasound-Guided Gastro-Jejunostomy (EUS-GJ). EMRs were reviewed to obtain anonymised data related to patient demographics, procedure duration, time to resolution of oral intake post procedure (defined as resumption of oral fluid/food consumption and absence of vomiting), survival, re-intervention rates, complications. We also reviewed our trends of case numbers comparing DS vs EUS GJ procedures per year

71 patients underwent duodenal stenting (31 female/40 male), while 33 underwent EUS GJ (20 female/13 male). Median age of DS group 67 years old (range 32-91) vs EUS GJ group 66 years old (range 37-86). Median survival of DS cohort 100 days (range 6-604 days) vs median survival of EUS GJ cohort 86 days (range 9-516 days). Median survival of DS cohort 100 days (range 6-604 days) vs median survival of EUS GJ cohort 86 days (range 9-516 days). Re-intervention rate in DS group: 26.7% (19/71) vs re-intervention rate of EUS GJ group: 6% (2/33). Median duration of DS procedure 31min (range 13-74min) vs median duration of EUS GJ procedure 49min (range 23-76min). Median time to resolution of GOO: 1 day in EUS GJ group (range 1-2 days) vs 1 day in DS group (range 1-7 days). Over the study period, the number of DS procedures per year has levelled off, while the number of EUS-GJ procedures completed annually has steadily risen year on year since 2022.

Over time, the volume of EUS GJ in our centre has increased steadily, from 1 case in 2022 to 15 cases to date in 2025. The role for DS has changed from the primary endoscopic method of GOO management to one used only in select cases. Re-intervention rates were higher in the DS group, in keeping with prior published experience. In our cohort, 47% of DS patients who required re-intervention for recurrence of GOO were successfully managed with EUS-GJ. EUS-GJ was seen to be safe, with no major complications noted during the study period, and was highly effective for definitive management of GOO with low rates of re-intervention. This study adds to the growing body of evidence in support of EUS-GJ for patients with malignant GOO.