Post written by Giuseppe Vanella, MD, from the Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Our article presents a prospective, single-center experience with EUS-guided gastroenterostomy (EUS-GE) for malignant gastric outlet obstruction and a matched comparison with a contemporary prospective cohort treated by enteral stenting.

At the study’s onset, prevailing evidence on EUS-GE was largely retrospective. Recognizing an urgent need for prospective insights, we initiated the Prospective Registry of Therapeutic Endoscopic Ultrasound (PROTECT; NCT04813055), encompassing all interventional EUS procedures and some standard comparators. As we monitored these patients closely, we observed a potential game-changer in the management of this condition.

As the largest prospective EUS-GE series to date, our research provides an in-depth look into the procedure’s technical aspects while verifying its efficacy and safety. Notably, in this first prospective comparison, EUS-GE outperformed enteral stenting in clinical success rates and showcased significantly fewer dysfunctions during follow-up.

We also noticed a promising trend toward faster initiation of chemotherapy. During the study interval, our center’s approach itself evolved, leaning more toward the primary use of EUS-GE while continuing to analyze the reasons behind our choices, delving into the contraindications to the procedure, and in turn refining our patient selection process.

In a rapidly evolving technological landscape, it is essential to adopt techniques that provide better patient outcomes. Although our study offers an initial glance at EUS-GE’s advantages, we eagerly await randomized data to further cement our findings, strengthen the procedure’s credibility, and further embed EUS-GE into clinical management algorithms.

My deepest gratitude extends to all collaborators and co-authors.

Graphical Abstract

Read the full article online.

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