Introduction Endoscopic ultrasound–guided gastroenterostomy (EUS-GE) has rapidly emerged as an important minimally invasive option for the management of gastric outlet obstruction, offering an alternative to surgical bypass and enteral stenting. As adoption increases globally, EUS-GE is being applied across increasingly diverse benign and malignant indications.
Introduction
Endoscopic ultrasound–guided gastroenterostomy (EUS-GE) has rapidly emerged as an important minimally invasive option for the management of gastric outlet obstruction, offering an alternative to surgical bypass and enteral stenting. As adoption increases globally, EUS-GE is being applied across increasingly diverse benign and malignant indications.
Problem Statement
Despite growing utilization, EUS-GE techniques remain highly variable among centers and operators, including differences in access methods, stent deployment strategies, procedural setup and adjunctive imaging techniques. This lack of standardization may contribute to heterogeneous clinical outcomes and creates challenges for training, quality assurance and procedural safety.
Summary
This international modified Delphi consensus provides the first structured expert-driven technical recommendations for standardizing EUS-guided gastroenterostomy. Through a multiround consensus process involving leading interventional endosonographers, the study identified broad agreement on several core procedural principles considered essential for safe and effective EUS-GE. Strong consensus supported routine fluoroscopic guidance, free-hand deployment of electrocautery-enhanced lumen-apposing metal stents and the requirement for operator expertise in managing major complications such as perforation, bleeding, stent dysfunction and misdeployment. Consensus was also achieved regarding procedural sedation, patient positioning and the use of saline for bowel distension. More nuanced topics—including dye use, optimal bowel distension techniques and preferred catheter-assisted approaches—generated moderate agreement, reflecting evolving operator preference and ongoing technical refinement. Importantly, several unresolved areas failed to achieve consensus, particularly regarding contrast utilization and superiority of specific technical approaches, highlighting persistent procedural heterogeneity and important future research priorities. Overall, this consensus document represents a major step toward procedural standardization in therapeutic EUS and provides a practical framework for training, quality improvement and safer adoption of EUS-GE in advanced endoscopy practice.
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