Endoscopic ultrasound-guided gastroenterostomy: another knock-out for simplification

In the last decade, EUS-guided gastroenterostomy (EUS-GE) has evolved into a first-line approach to managing patients with malignant gastric outlet obstruction (GOO) [1]. During this timeframe we have witnessed a surge in clinical data, evolving from small retrospective series into matched multicenter comparisons, prospective series, and more recently randomized controlled trials (RCTs) [2] [3] [4]. The results of the first RCT to be made available seem to confirm previous findings [3], showing that EUS-GE has overcome the limitations of duodenal stenting whilst achieving a similar safety profile [4]. Although its efficacy has been proven beyond any doubt and maldeployment subtypes have been defined, safety and patient selection have remained inadequately explored to date [5] [6]. This mostly stems from the fact that the procedure had not been standardized, complicating comparisons between approaches.