Role of Endoscopic Ultrasound–Guided Gastrointestinal Anastomosis for Gastric Outlet Obstruction, Endoscopic Access, and Enteric Decompression

Endoscopic ultrasound (EUS)-guided gastrointestinal anastomosis techniques using lumen-apposing metal stents are increasingly being used in expert centers throughout the world and have already found their way into day-to-day practice. For patients with gastric outlet obstruction, EUS-guided gastroenterostomy has the potential to become the new reference standard given the most recent prospective data of long-term effectiveness in the setting of oncologic palliation, as well as the promising evidence regarding benign obstruction in poor surgical candidates. For patients with surgically altered anatomy, EUS-directed transgastric or transenteric endoscopic retrograde cholangiopancreatography (ERCP) seems to provide more effective and less invasive alternative to enteroscopy-assisted ERCP and laparoscopy-assisted ERCP. Besides access or management of gastric outlet obstruction, EUS-guided gastrointestinal anastomosis is furthermore increasingly being used for the palliation of afferent loop syndrome, showing high clinical success rates and acceptable safety profile. This also pertains to EUS-directed enterocolostomy, where small series have suggested a potential benefit for patients with malignant intestinal obstruction, although more data are required regarding patient selection and safety. In this review, we discuss the most recent evidence, technical approaches, and future directions for these techniques.