Karagyozov PI, Kavrakov D, Shumka N. Endoscopic ultrasound-guided gastroenterostomy: The new standard treatment of gastric outlet obstruction. Artif Intell Gastrointest Endosc 2025; 6(2): 106600 [DOI: 10.37126/aige.v6.i2.106600]
Corresponding Author of This Article
Petko Ivanov Karagyozov, MD, PhD, Associate Professor, FASGE, Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda University Hospital, 51B N. Vaptzarov Blvd, Sofia 1407, Bulgaria. petko.karagyozov@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Artif Intell Gastrointest Endosc. Jun 8, 2025; 6(2): 106600 Published online Jun 8, 2025. doi: 10.37126/aige.v6.i2.106600
Endoscopic ultrasound-guided gastroenterostomy: The new standard treatment of gastric outlet obstruction
Petko Ivanov Karagyozov, Daniel Kavrakov, Nadica Shumka
Petko Ivanov Karagyozov, Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda University Hospital, Sofia 1407, Bulgaria
Daniel Kavrakov, Nadica Shumka, Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic University Hospital Tokuda, Sofia 1407, Bulgaria
Author contributions: Karagyozov P, Kavrakov D, and Shumka N contributed equally to the conception and design of this review; Karagyozov P drafted the manuscript; Kavrakov D and Shumka N contributed to the literature review and critical revision of the manuscript; All authors approved the final version of the manuscript
Conflict-of-interest statement: All authors declare no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Petko Ivanov Karagyozov, MD, PhD, Associate Professor, FASGE, Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda University Hospital, 51B N. Vaptzarov Blvd, Sofia 1407, Bulgaria. petko.karagyozov@gmail.com
Received: March 3, 2025 Revised: April 2, 2025 Accepted: April 21, 2025 Published online: June 8, 2025 Processing time: 96 Days and 12.7 Hours
Abstract
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction. Compared to traditional options, including duodenal stenting and surgical gastrojejunostomy, EUS-GE offers comparable technical and clinical success while providing longer-lasting patency, fewer adverse events, and lower reintervention rates. The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome. EUS-GE enables rapid recovery and early resumption of oral intake, which is crucial for oncologic patients. However, the procedure remains technically demanding, and optimal techniques, device selection, and management of complications are still under investigation. This mini-review summarizes current evidence, compares EUS-GE with alternative therapies, discusses patient selection and procedural aspects, and outlines key areas for future research.
Core Tip: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a promising minimally invasive treatment for gastric outlet obstruction, challenging traditional surgical gastrojejunostomy and duodenal stenting. It offers rapid recovery, improved symptom relief, and reduced reintervention rates, particularly benefiting oncologic patients. Despite its advantages, EUS-GE remains technically complex, requiring refinement in technique, standardization, and training programs. Issues such as stent misdeployment, long-term outcomes, and best technical approaches remain unresolved. Further studies, including randomized trials, are needed to establish EUS-GE as the standard of care, optimize safety, and expand indications, including potential applications in bariatric endoscopy and gastroparesis management.
