title: Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience.
abstract: BACKGROUND
  Surgical gastrojejunostomy and enteral self-expanding metal stents are efficacious for the management of gastric outlet obstruction but limited by high complication rates and short-term efficacy. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is a novel alternative option.
  
  
  METHODS
  Patients who underwent EUS-GJ between March 2014 and September 2015 as part of a prospective multicenter registry at four academic centers in two countries were included. Technical success was defined as successful placement of a gastrojejunal lumen-apposing metal stent. Clinical success was defined as the ability of the patient to tolerate an oral diet. Post-procedural adverse events were recorded.
  
  
  RESULTS
  The study included 26 patients, of whom 11 (42 %) were male. Technical success was achieved in 24 patients (92 %). Clinical success was achieved in 22 patients (85 %). Of the 4 patients in whom clinical success was not achieved, 2 had persistent nausea and vomiting despite a patent EUS-GJ and required enteral feeding for nutrition, 1 died before the initiation of an oral diet, and 1 underwent surgery for suspected perforation. Adverse events, including peritonitis, bleeding, and surgery, occurred in 3 patients (11.5 %).
  
  
  CONCLUSIONS
  EUS-GJ is an emerging procedure that has efficacy and safety comparable with those of current therapies and should hold a place as a new minimally invasive option for patients with gastric outlet obstruction. Clinical trial identification number: NCT01522573.
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Perez-Miranda
authors.affiliation: Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Sanchez-Ocaña
authors.affiliation: Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Peñas
authors.affiliation: Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: de la Serna
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Janak
authors.initials: J
authors.lastname: Shah
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Binmoeller
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Grimm
authors.affiliation: Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Baron
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh