Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2021; 13(7): 620-632
Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.620
Endoscopic ultrasound guided gastrojejunostomy for gastric outlet obstruction
Sebastian Stefanovic, Peter V Draganov, Dennis Yang
Sebastian Stefanovic, Department of Gastroenterology and Hepatology, University Medical Center Ljubljana, Ljubljana 1000, Slovenia
Peter V Draganov, Dennis Yang, Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, FL 32608, United States
Author contributions: Stefanovic S, Draganov PV and Yang D have been involved in literature search and writing the manuscript; Draganov PV and Yang D conceived the idea of the manuscript and performed the final revision of the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: Sebastian Stefanovic has no conflict of interests to declare. Dr Draganov is a consultant for Olympus, Boston Scientific, Cook Medical, Fuji, Merit, Steris, MicroTech and Medtronic. Dr Yang is a consultant for Boston Scientific, Steris, and Lumendi.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dennis Yang, MD, Doctor, Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, 1329 SW 16th Street, Room #5252, Gainesville, FL 32608, United States. dennis.yang@medicine.ufl.edu
Received: January 30, 2021
Peer-review started: January 30, 2021
First decision: May 10, 2021
Revised: May 11, 2021
Accepted: June 23, 2021
Article in press: June 23, 2021
Published online: July 27, 2021

Gastric outlet obstruction (GOO) is a clinical syndrome secondary to luminal obstruction at the level of the stomach and/or duodenum. GOO can be caused by either benign or malignant etiologies, often resulting in early satiety, nausea, vomiting and poor oral intake. GOO is associated with decreased quality of life and has been shown to significantly impact survival in patients with advanced malignancies. Traditional treatment options for GOO can be broadly divided into surgical [surgical gastrojejunostomy (GJ)] and endoscopic interventions (dilation and/or placement of luminal self-expanding metal stents). While surgical GJ has been shown to provide a more lasting relief of symptoms when compared to luminal stenting, it has also been associated with a higher rate of adverse events. Furthermore, many patients with advanced metastatic disease are not good surgical candidates. More recently, endoscopic ultrasound (EUS)-guided GJ has emerged as a potential alternative to traditional surgical and endoscopic approaches. This review focuses on the new advances and technical aspects of EUS-GJ and clinical outcomes in the management of both benign and malignant disease.

Keywords: Gastric outlet obstruction, Interventional endoultrasonography, Gastrojejunostomy, Duodenal stenting, Balloon dilatation

Core Tip: Gastric outlet obstruction (GOO) can significantly decrease the quality of life and also significantly impact survival of patients with malignant etiology. Endoscopic luminal stenting and surgery are considered standard therapy; however, issues remain. Luminal stenting is minimally invasive but often requires reinterventions whereas longer-lasting surgical bypass procedures are associated with higher morbidity. Endoscopic ultrasonography-guided gastroenterostomy has emerged as an alternative to these established therapies. We aim to analyze the technical aspects of endoscopic ultrasonography-guided gastroenterostomy, review its clinical outcomes and propose a treatment algorithm for patients with malignant GOO.