EUS-guided Gastrojejunostomy Versus Laparoscopic Gastrojejunostomy: An International Collaborative Study

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery

Background:

• Gastric outlet obstruction (GOO) management often involves surgical intervention.
• Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) offers a minimally invasive alternative to traditional laparoscopic gastrojejunostomy (Lap-GJ).
• Direct comparative data between EUS-GJ and Lap-GJ for GOO is limited.

Purpose of the Study:

• To compare the clinical outcomes, success rates, and adverse events (AE) of EUS-GJ versus Lap-GJ in patients with GOO.
• To evaluate the safety and efficacy of EUS-GJ as a treatment for GOO.

Main Methods:

• A retrospective analysis of 54 patients with GOO from four academic centers across three countries.
• Patients underwent either EUS-GJ (n=25) or Lap-GJ (n=29).
• Technical success (gastrojejunostomy creation) and clinical success (diet tolerance) were assessed, along with AE using the Clavien-Dindo Classification.

Main Results:

• Technical success rates were 88% for EUS-GJ and 100% for Lap-GJ (P=0.11).
• Adverse events occurred in 12% of EUS-GJ patients versus 41% of Lap-GJ patients (P=0.0386).
• AE in the Lap-GJ group included higher grades (I, II, III, V) compared to EUS-GJ (II, V).

Conclusions:

• EUS-GJ demonstrated comparable efficacy to Lap-GJ in GOO patients, even in more complex cases.
• EUS-GJ is associated with significantly lower rates of adverse events, indicating a favorable safety profile.
• EUS-GJ represents a safe, effective, and minimally invasive therapeutic option for managing gastric outlet obstruction.