Endoscopic approaches to small bowel strictures

Small bowel strictures secondary to either benign or malignant causes are associated with significant morbidity and impaired quality of life. Symptoms and their severity are dependent on the location and the degree of stenosis which, in addition to the etiology, dictate the approach to treatment. Endoscopic management of small bowel strictures include endoscopic balloon dilation, enteral stenting, endoscopic ultrasound-guided gastroenterostomy (EUS-GE), and stricturotomy. The introduction of the cautery-enhanced lumen-apposing metal stent has streamlined EUS-GE and has brought it to the forefront especially for select patients with malignant gastric outlet obstruction (GOO) with acceptable survival. This review will summarize the literature regarding the aforementioned interventions and will focus on EUS-GE and how it compares with traditional use of enteral stents and surgical gastrojejunostomy in the management of malignant GOO.