Post written by Takayoshi Tsuchiya, MD, PhD, FJGES, from the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.

This study focuses on the long-term outcomes of the EUS-guided balloon-occluded gastrojejunostomy bypass (EPASS) technique for malignant gastric outlet obstruction (GOO). EPASS is a novel procedure developed by our team at Tokyo Medical University that combines a double-balloon enteric tube and lumen-apposing metal stents to improve procedural safety and efficacy. By evaluating its clinical and technical success rates, stent patency, and patient survival, we aim to provide evidence supporting its application in clinical practice.

GOO significantly affects quality of life, especially in patients with advanced malignancies. Although EUS-guided gastroenterostomy has shown promise as a minimally invasive treatment, adverse events such as jejunal collapse and suboptimal visualization during stent placement persist. EPASS was developed to address these challenges, but long-term outcomes were not comprehensively studied. By providing robust data on clinical and technical success rates, as well as stent patency and patient survival, this study strived to validate EPASS as a preferred option for palliating malignant GOO.

The study demonstrated that EPASS achieved a high technical success rate (94.6%) and clinical success rate (89.2%), with a 100% stent patency rate during follow-up. The procedure also showed significant improvements in patients’ GOO scoring system scores and manageable adverse event rates (16.2%). Importantly, these results were observed in a cohort of patients with advanced-stage malignancies, highlighting EPASS’s reliability even in challenging cases.

Compared with conventional EUS-guided gastroenterostomy techniques, EPASS offers unique advantages, including enhanced procedural precision and reduced risk of stent migration, thanks to the innovative double-balloon system. Moreover, shorter hospital stay and improved quality of life for patients make it a compelling alternative to laparoscopic gastrojejunostomy and other methods.

As the first study, to our knowledge, to evaluate long-term outcomes of EPASS from the development facility, this research underscores the technique’s contribution to advancing minimally invasive treatments for GOO. However, limitations such as the single-center, retrospective design and restricted availability of double-balloon enteric tubes necessitate further research.

Future steps should include prospective, multicenter randomized controlled trials to compare EPASS with other treatment modalities and evaluate its broader applicability. Furthermore, development and commercialization of dedicated devices could expand its accessibility and adoption worldwide.

Graphical abstract

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