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EUS-guided Gastroenterostomy After Disuse of Enteric Metal Stents for Malignant Gastric Outlet Obstruction

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) appears to be suitable for malignant gastric outlet obstruction (GOO), serving as a hybrid treatment that includes the advantages of a long unobstructed period and less invasiveness. Two patients each, described in this report, had an unresectable cancer and underwent endoscopic metal stent placement in the stenotic enteric segment of a malignant GOO, which resulted in frequent stent replacement. EUS-GE was then performed with a fully covered, self-expandable, lumen-apposing metal stent, which combined a cautery tip-equipped access catheter. The patients’ symptoms of nausea and vomiting were rapidly alleviated and did not recur during the follow-up period of 6 months. EUS-GE appears to be feasible after obstruction of a metal stent in a tumor segment. It may be a preferred alternative in patients with malignant GOO.