Endoscopic approach preferred over surgery in gastric outlet syndrome

In patients with gastric outlet syndrome, endoscopic gastroenterostomy resulted in a shorter time to oral intake of solid food than surgical gastrojejunostomy. Additionally, re-intervention rates were comparable between the 2 study arms.

“Patients with malignant gastric outlet obstruction who have a good performance status are traditionally managed surgically to re-establish intake of solid food,” explained Dr Yorick van de Pavert (University Medical Centre Utrecht, the Netherlands) [1]. “Although this is an effective procedure, it has been associated with morbidities such as persistent gastroparesis.”

The ENDURO trial aimed to investigate whether an endoscopic approach could reduce the time to oral intake while maintaining comparable re-intervention rates [2]. The research team randomised 98 participants with gastric outlet syndrome caused by a metastatic or unresectable malignancy (1:1) to undergo either endoscopic ultrasonography-guided gastroenterostomy or surgical gastrojejunostomy. The primary endpoints were time to oral intake of solid food and re-intervention rate at 6 months.

Participants in the endoscopy arm had a median of 1 day to initiation of oral intake, compared to 3 days for participants in the surgery arm, representing a significant difference in favour of the endoscopy arm (HR 2.21; 95% CI 1.43–3.42; P=0.0003). Furthermore, the re-intervention rate for recurrent or persistent obstructive symptoms was 10% in the endoscopy arm and 12% in the surgery arm, clearly meeting the non-inferiority criterion. “In the endoscopy arm, 2 participants required surgical gastrojejunostomy and 3 participants received a second lumen-apposing metal stent,” Dr van de Pavert elaborated. “The 6 re-interventions in the surgery arm were all performed to install a feeding tube and/or provide parenteral nutrition.”

Finally, the median length of hospital stay was 1 day in the endoscopy arm and 4 days in the surgery arm (relative change 0.46; 95% CI 0.20–0.78; see Figure).

Figure: Secondary endpoint results from the ENDURO study [1]



In conclusion, endoscopic gastroenterostomy provided a faster time to resume oral intake and a shorter hospital stay while maintaining non-inferior re-intervention rates compared with a surgical approach.

1. Van de Pavert YL, et al. Endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for palliation of malignant gastric outlet obstruction (ENDURO). OP001, Plenary Session, UEG Week, 4–7 October 2025, Berlin, Germany.
2. Kastelijn JB, et al. Trials. 2023;24(1):608.

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Posted on 1 December 20251 December 2025