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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.)

This article discusses a study comparing two techniques for endoscopic ultrasound guided gastroenterostomy (EUS-GE), a procedure used to manage gastric outlet obstruction. The study compared the outcomes of a wireless technique (WEST) and a technique using a guided-wire (DTOG). The results showed that the WEST technique had higher technical success, lower misdeployment rate, shorter procedure time, and fewer attempts compared to the DTOG technique. Additionally, the study found that a rescue therapy using a stent-in-stent technique was effective in cases of misdeployment. Overall, the study suggests that the WEST technique may be a better option for EUS-GE, and the stent-in-stent technique is a reliable rescue therapy. [Extracted from the article]

This article discusses the use of EUS-guided gastroenterostomy (EUS-GE) as an alternative treatment for benign gastric outlet obstruction (bGOO). The study evaluated the outcomes of EUS-GE in 25 patients with bGOO, with 80% of them considered to be at high surgical risk. The results showed that EUS-GE was successful in achieving technical success in all cases, with 88% of patients not requiring surgical management. However, there were some long-term adverse events observed, including jejunal ulcer and LAMS occlusion. The study concludes that EUS-GE is a viable option for high surgical risk patients, but the risk of long-term adverse events and recurrence of occlusion should be considered. [Extracted from the article]