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1:  The European Society of Gastrointestinal Endoscopy (ESGE) adheres to the overarching principles of equality of opportunity, fair treatment, nondiscrimination, and diversity of health care professionals. 2:  ESGE strongly supports the creation of collaborations within and between national and international endoscopy societies to disseminate the principles of diversity, equality, and inclusion (DEI) in the field of gastrointestinal (GI) endoscopy. 3:  ESGE aims to reflect the diversity of its membership in all its scientific and educational activities. 4:  ESGE supports the fostering of collaborative work settings that empower all members of the endoscopy team to reach their full potential. 5:  ESGE supports international and national endoscopy societies in promoting equitable access to high quality endoscopy training. 6:  ESGE recommends the implementation of ergonomic principles in endoscopy units to prevent injuries and to provide adapted workplace conditions for personnel with disabilities and/or special needs. 7:  ESGE recommends comprehensive mentorship, that includes diverse backgrounds, and equitable sponsorship for professional development, training, and academic excellence. 8:  ESGE recommends that endoscopists actively identify, discuss, and attempt to accommodate reasonable patient preferences and expectations regarding endoscopy procedures. 9:  ESGE advocates for educational and awareness campaigns targeting both health care professionals and patients, as well as the adoption of cost-effective health care strategies to address disparities and enhance equity in endoscopy care. 10:  ESGE is committed to increasing support for underrepresented scholars and minorities pursuing research in endoscopy. 11:  ESGE identifies mentorship and sponsorship as factors that may mitigate the barriers to academic careers for underrepresented endoscopy scholars. 12:  ESGE recognizes the need to increase awareness of diversity, equity, and inclusion (DEI) in the field of endoscopy and supports publications on these topics., Competing Interests: No competing interests have been declared by any author., (European Society of Gastrointestinal Endoscopy. All rights reserved.)

Background: Endoscopic duodenal stenting is the current standard treatment for malignant gastric outlet obstruction (GOO) in patients with limited life expectancy. However, duodenal stenting is prone to stent dysfunction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique with potentially superior stent patency. We compared clinical success, safety, and stent dysfunction of EUS-GE and duodenal stenting in patients with malignant GOO using propensity score matching., Methods: This international, multicenter, retrospective study analyzed consecutive patients undergoing EUS-GE or duodenal stenting for GOO between 2015 and 2021 in three European centers. Primary outcomes were clinical success (GOO scoring system [GOOSS] ≥ 2) and stent dysfunction (GOOSS ≤ 1 after initial clinical success). A propensity score matching (1:1) analysis was performed using age, sex, underlying disease, disease stage, ascites, and peritoneal carcinomatosis as variables., Results: 214 patients underwent EUS-GE (n = 107) or duodenal stenting (n = 107). After propensity score matching, 176 patients were matched and compared. Technical success rates for EUS-GE and duodenal stenting were 94 % (95 %CI 89 %-99 %) vs. 98 % (95 %CI 95 %-100 %), respectively ( P  = 0.44). Clinical success rates were 91 % (95 %CI 85 %-97 %) vs. 75 % (95 %CI 66 %-84 %; P  = 0.008). Stent dysfunction occurred in 1 % (95 %CI 0-4 %) vs. 26 % (95 %CI 15 %-37 %) of patients ( P  < 0.001). Adverse event rate was 10 % (95 %CI 4 %-17 %) vs. 21 % (95 %CI 12 %-29 %; P  = 0.09)., Conclusion: EUS-GE had higher clinical success and lower stent dysfunction, with similar safety, compared with duodenal stenting, suggesting that EUS-GE may be preferred over duodenal stenting in patients with malignant GOO., Competing Interests: RLJ van Wanrooij is a consultant for Boston Scientific. M Bronswijk is a consultant for Taewoong – Prion Medical. W Laleman is Co-Chair of the Boston Scientific Therapeutic Biliopancreatic Endoscopy group, and is a consultant for Boston Scientific and Cook. H van Malenstein is a consultant for Boston Scientific. P Fockens is a consultant for Olympus and Cook Medical. SW van der Merwe is Co-Chair of the Boston Scientific Therapeutic Biliopancreatic Endoscopy group and Chair of the Portal Hypertension group for Cook; he is also a consultant for Cook, Boston Scientific, and Pentax. RP Voermans is a consultant for Boston Scientific and has received research grants from Boston Scientific and Taewoong - Prion Medical. The remaining authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Michiel Bronswijk has received grants from Prion Medical, Taewoong, and Takeda, and has consultancy agreements with Prion Medical and Taewoong. Diederik Persyn, Thomas Billiet, and Ruben Spitaels declare no conflicts of interest. Hannah van Malenstein has consultancy agreements with Boston Scientific. Schalk Van der Merwe holds the Cook and Boston-Scientific chair in interventional endoscopy and holds consultancy agreements with Cook, Pentax, and Olympus.