Outcomes of Endoscopic Ultrasound-guided Gastroenterostomy Using Lumen-apposing Metal Stent in the Treatment of Malignant and Benign Gastric Outlet Obstruction: A Case Series


  • Kannikar Laohavichitra Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
  • Jerasak Wannaprasert Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
  • Thawee Ratanachu-ek Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand




EUS-guided gastroenterostomy, lumen-apposing metal stent, gastric outlet obstruction, benign, malignant


Objective: To study the outcomes of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumenapposing metal stent (LAMS) in patients with benign and malignant gastric outlet obstruction (GOO).

Materials and Methods: This single-center study retrospectively reviewed the medical records of benign and malignant GOO patients who underwent EUS-GE between May 2019 and September 2023. We evaluated the technical success, adverse events related to the techniques used, clinical success, and recurrence and reintervention rates.

Results: A total of twelve patients who underwent three different EUS-GE techniques were included in this study. The first method was the direct over-the-guidewire technique, the second was the wireless-freehand method, and the third was modified endoscopic ultrasound-guided double-balloon occluded gastroenterostomy bypass (M-EPASS). All 3 techniques used preloaded oroenteral catheters in combination. Technical success was achieved in 83.3% (10/12) of patients, and there were 16.6% (2/12) failures due to misdeployment. One (8.3%) severe adverse event occurred resulting in peritonitis during the direct over-the-guidewire method. The second failure, which ensued after use of the wireless-freehand technique, achieved successful stent deployment at the second attempt without any complications. Clinical success was 100% (11/11), and mean follow up was 6.2 months. There was one (9.1 %) incidence of recurrence at 12-month follow up.

Conclusion: EUS-GE is effective in the management of GOO, and the wireless-freehand and M-EPASS techniques in combination with oroenteral catheters should be the technique of choice in term of safety and efficacy.


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How to Cite

Laohavichitra, K., Wannaprasert, J. ., & Ratanachu-ek, T. . (2024). Outcomes of Endoscopic Ultrasound-guided Gastroenterostomy Using Lumen-apposing Metal Stent in the Treatment of Malignant and Benign Gastric Outlet Obstruction: A Case Series. Siriraj Medical Journal, 76(4), 174–181. https://doi.org/10.33192/smj.v76i4.267242



Original Article