Endoscopic approach preferred over surgery in gastric outlet syndrome

In patients with gastric outlet syndrome, endoscopic gastroenterostomy resulted in a reduced time to oral intake of solid food compared with surgical gastrojejunostomy. Additionally, re-intervention rates were comparable between the two 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. The research team randomised 98 patients 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.

Patients in the endoscopy arm had a median time to initiation of oral intake of 1 day, compared to 3 days for patients 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 patients required surgical gastrojejunostomy and 3 patients 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).

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.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 6 October 20256 October 2025