# Benign gastric outlet obstruction: evolving strategies from surgery to endoscopic ultrasound-guided gastrojejunostomy

## TL;DR

This review discusses new, less invasive treatments for a stomach blockage condition, highlighting a promising technique that could replace traditional surgery for some patients.

## Contribution

The paper evaluates the growing evidence supporting endoscopic ultrasound-guided gastrojejunostomy as a superior treatment for benign gastric outlet obstruction.

## Key findings

- Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) achieves over 95% technical and clinical success rates.
- EUS-GJ has lower recurrence and complication rates compared to traditional surgical and endoscopic methods.
- EUS-GJ is increasingly preferred for refractory or high-risk benign gastric outlet obstruction cases.

## Abstract

Benign gastric outlet obstruction (bGOO) presents a significant therapeutic challenge, with etiologies ranging from peptic strictures to complex postsurgical or inflammatory conditions. While surgery has historically offered durable outcomes, its morbidity in frail populations underscores the need for effective, less invasive alternatives. This review critically examines the current literature up to April 2025 on surgical, endoscopic, and endoscopic ultrasound-guided interventions for bGOO, evaluating technical success, clinical outcomes, recurrence rates, and adverse events. Endoscopic balloon dilation shows excellent efficacy in simple peptic strictures but has limited efficacy in anatomically complex cases. Fully covered self-expandable metal stents can provide temporary relief but are associated with significant migration risk. Among emerging techniques, endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) stands out by combining the anatomical efficacy of surgery with the minimal invasiveness of endoscopy. Recent studies report technical and clinical success rates exceeding 95%, with lower recurrence and complication rates compared to traditional approaches. Comparative data increasingly support EUS-GJ as the preferred option in refractory or high-risk patients. Tailoring treatment strategies based on etiology, anatomical complexity, and patient condition is essential. EUS-GJ is redefining the therapeutic landscape of bGOO, offering a minimally invasive and durable alternative to surgery in carefully selected cases.

Novel therapeutic approaches improve outcomes for patients with obstructive gastrointestinal symptoms caused by benign diseases

Some people may develop a gastrointestinal obstruction at the exit of the stomach, caused by scarring, inflammation, or previous surgery. This condition, known as benign gastric outlet obstruction (bGOO), can lead to symptoms such as nausea, vomiting, weight loss, and malnutrition. While surgery has long been the standard treatment, it may not be suitable for elderly or frail patients due to its associated risks. This review examines more modern and less invasive therapies, including an innovative technique called endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ), which creates a new pathway for food to bypass the obstruction. Recent studies show that EUS-GJ is highly effective, safe, and associated with faster recovery times. It may soon become the first-line treatment for selected patients with benign gastric outlet obstruction.