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Competing Interests: L. Monino is a consultant for Taewoong Medical, Fujifilm and Prion Medical, and has received speaker’s fees from Olympus Belgium and Olympus Europe. T. G. Moreels has received speaker’s fees from Olympus Belgium and Olympus Europe. L. Marique, Y. Deswysen, B. Navez, and E. Danse declare that they have no conflict of interest.

Competing Interests: LM is consultant for Prion Medical and Braun Medical and received speaker’s fees from Olympus Belgium and Olympus Europe. PHD is consultant for Boston Scientific TGM received speaker’s fees from Olympus Belgium and Olympus Europe. Others authors declare that they have no conflict of interest.

Competing Interests: L. Monino is consultant for Prion Medical and Braun Medical, and is a speaker for Olympus Belgium and Olympus Europe. T.G. Moreels is a speaker for Olympus Belgium and Olympus Europe. R. Bachmann, D. Leonard, C. Remue, E. Danse, and A. Kartheuser declare that they have no conflict of interest.

Background: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMSs) appears to be effective and safe in gastric outlet obstruction (GOO); however, the EUS-GE procedure is not standardized, with the use of assisted or direct methods still debated. The aim of this study was to compare the outcomes of EUS-GE techniques focusing on an assisted with orointestinal drain wireless endoscopic simplified technique (WEST) and the nonassisted direct technique over a guidewire (DTOG)., Method: This was a multicenter European retrospective study involving four tertiary centers. Consecutive patients who underwent EUS-GE for GOO between August 2017 and May 2022 were included. The primary aim was to compare the technical success and adverse event (AE) rates of the different EUS-GE techniques. Clinical success was also analyzed., Results: 71 patients (mean [SD] age 66.2 10 years; 42.3 % men; 80.3 % malignant etiology) were included. Technical success was higher in the WEST group (95.1 % vs. 73.3 %; estimate of relative risk from odds ratio (eRR) 3.2, 95 %CI 0.94-10.9; P  = 0.01). The rate of AEs was lower in the WEST group (14.6 % vs. 46.7 %; eRR 2.3, 95 %CI 1.2-4.5; P  = 0.007). Clinical success was comparable between the two groups at 1 month (97.5 % vs. 89.3 %). The median follow-up was 5 months (range 1-57)., Conclusion: The WEST resulted in a higher technical success rate with fewer AEs, with clinical success comparable with the DTOG. Therefore, the WEST (with an orointestinal drain) should be preferred when performing EUS-GE., Competing Interests: L. Monino is a consultant for Prion Medical and Braun Medical and has received speaker’s fees from Olympus Belgium and Olympus Europe. E. Pérez-Cuadrado-Robles and J.-M. Gonzalez are consultants for Boston Scientific. P. H. Deprez is a consultant for Boston Scientific and Olympus Europe. T. G. Moreels has received speaker’s fees from Olympus Belgium and Olympus Europe. M. Barthet is a consultant for Boston Scientific.C. Snauwaert, H. Alric, M. Gasmi, S. Ouazzani, H. Benosman, G. Rahmi, and C. Cellier declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Introduction: Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % - 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation., Methods: A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow - Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach., Results: HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred., Conclusion: POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Prof. Barthet and Dr. Gonzalez are consultants for Boston Scientific. Dr. Serrero is a consultant for AbbVie, Takeda, and Janssen, and speaker for AbbVie, Takeda, Janssen, and MSD.

Competing Interests: None

Competing Interests: None

Competing Interests: None