Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged as the standard of care for gastric outlet obstruction (GOO), owing to its high short-term clinical success and favorable safety profile. Nevertheless, long-term outcome data remain limited. The aim of this study is to evaluate the factors associated with the EUS-GE outcomes and to assess the durability of clinical success during long-term follow-up.

All consecutive patients undergoing EUS-GE to treat GOO at a single center between May 2022 and October 2025 were enrolled in this retrospective study. Data on patient demographics, procedure-related details, type of lumen apposing metal stent (LAMS) used and follow-up results were collected. Primary outcomes included technical success, clinical success, and adverse events (AEs). The secondary outcome was the assessment of clinical success during mid-term (6 months) and long-term (12 months or more) follow-up. 

Fifty-two patients who underwent EUS-GE (mean age 62.65 [SD 13.71], male 51.9%, malignant indication 86,5%) were included. Median follow-up duration was 100.5 days (IQR 60-221). Technical success, defined as successful LAMS deployment, was 96,2%. Clinical success, defined as Gastric Outlet Obstruction Scoring System (GOOSS) ≥2  at 7 days was 94%. Intraprocedural AEs - stent misdeployment (SM) were observed in 10% of patients with no association between LAMS type (15/10mm or 20/10mm Hot Axios Boston Scientific, USA/ 16/20mm Hot Spaxus Taewoong Medical, Seoul, Sauth Korea, p=0.331), peritoneal carcinomatosis (p=0.154), ascites (p=0.400), shape of target loop (longitudinal/oval, p= 1.000) and serum albumin level (SM group 33g/L [IQR 15]/without SM group 35g/l [IQR 11], p=0.737). All SMs were managed by NOTES approach. The rate of short-term AEs was 10%, associated only with etiology (p=0.036). Long-term AEs, mostly procedure-related due to stent migration and ingrowth, occurred in 18% of cases without association with previous surgery (p=0.214), site of obstruction (p=0.293), diameter, length, and type of LAMS (p=1.000). At the 6-month follow-up, among alive patients /N=24/, 12.5% had a GOOSS=2 and 87.5% had GOOSS=3, without recurrence of symptoms. During the long-term follow-up at 12 months, symptom recurrence was observed in one patient with Diffuse Large B-Cell Gastric Lymphoma. Endoscopy found complete obliteration of the pylorus and stent ingrowth, successfully managed with the stent-in-stent technique. Thus, a final-12-month GOOSS of 2 and 3 was observed in 28.6% and 71.4% of patients, respectively. 

To our knowledge, this study is one of the first to assess the performance of different types of LAMS in the context of EUS-GE, demonstrating comparable outcomes across stent types and showing that neither target intestinal loop shape nor serum albumin levels, in contrast to the surgical approach, significantly influenced procedural or long-term results. Our findings suggest that mid and long-term outcomes of EUS-GE are primarily determined by disease etiology, emphasizing the importance of appropriate patient selection.