Background: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an emerging
technique widely described and accepted for the treatment of gastric outlet obstruction (GOO).
Future challenges will involve improving this technique and targeting the optimal enteral loop.
We propose a retrospective analysis of consecutive cases of patients who underwent EUS-GE
procedures with lumen apposing metal stent (LAMS) for GOO with a nasofibroscope
simultaneously orally inserted to enhance the visualization of the enteral loop.
Methods: We included 22 consecutive patients who underwent EUS-GE for GOO due to
benign or malignant diseases. The primary endpoints were to assess the technical and clinical
efficacy of EUS-GE with a nasofibroscope. Clinical success was defined by a GOOSS (gastric
outlet obstruction scoring system) score of 2 or 3 in the interval between the third and tenth
day following the intervention and at the last follow-up. Secondary outcomes included
procedure-related adverse events such as bleeding, perforation, or stent migration, the need for
re-intervention, and the time of hospitalization following the procedure.
Results: The overall technical and clinical success rates were 100% and 90.9%, respectively.
Before intervention, the median GOOSS score was 1, while post-intervention (between the
third- and tenth- day post-procedure) and at the last follow-up, the median GOOSS score was
3. Adverse events occurred in 18.2% of patients, none severe according to the AGREE
classification. Reinterventions due to EUS-GE-associated complications were performed on
13.6% of patients, all managed endoscopically. The hospital stay after procedure was 4 (IQR
1 – 10) days.
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Conclusion: A nasofibroscope can be used to improve the visualization of the targeted enteral
loop and facilitate its puncture, which are the longest and hardest steps of EUS-
gastroenterostomy.