UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

ENDOSCOPIC ULTRASONOGRAPHY-GUIDED GASTROENTEROSTOMY VERSUS SURGICAL GASTROJEJUNOSTOMY FOR PALLIATION OF MALIGNANT GASTRIC OUTLET OBSTRUCTION (ENDURO)

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

ENDOSCOPIC ULTRASONOGRAPHY-GUIDED GASTROENTEROSTOMY VERSUS SURGICAL GASTROJEJUNOSTOMY FOR PALLIATION OF MALIGNANT GASTRIC OUTLET OBSTRUCTION (ENDURO)

Yorick van de Pavert 1, Janine Kastelijn 1, Marc G. Besselink 2, Dieke C. Booij 3, Jurjen J. Boonstra 4, Judith Boot 1, Marco J. Bruno 3, Olivier R.C. Busch 2, Freek Daams 5, Wouter J.M. Derksen 6, Paul Fockens 7, Bas Groot Koerkamp 8, Jeroen Hagendoorn 9, Jeanin van Hooft 4, Akin Inderson 4, Willem Lammers 3, Daan J. Lips 10, Sven Mieog 4, I. Quintus Molenaar 9, Alexander A.F.A. Veenhof 11, Niels G. Venneman 10, Robert C. Verdonk 12, Rogier P. Voermans 2, Roy LJ van Wanrooij 13, Paco M.J. Welsing 1, Thomas de Wijkerslooth 11, Leon M.G. Moons 1, Hjalmar C. van Santvoort 14, Frank P. Vleggaar 1

Affiliations

1 UMC Utrecht, Utrecht, Netherlands

2 Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands|||Cancer Center Amsterdam, Amsterdam, Netherlands

3 Erasmus University Medical Center, Rotterdam, Netherlands

4 Leiden University Medical Center, Leiden, Netherlands

5 Amsterdam UMC, Location Vrije Universiteit, Amsterdam, Netherlands|||Cancer Center Amsterdam, Amsterdam, Netherlands

6 St. Antonius Hospital, Nieuwegein, Netherlands|||UMC Utrecht, Utrecht, Netherlands

7 Cancer Center Amsterdam, Amsterdam, Netherlands|||Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands

8 Erasmus University Medical Center Cancer Institute, Rotterdam, Netherlands

9 UMC Utrecht, Utrecht, Netherlands|||St. Antonius Hospital, Nieuwegein, Netherlands

10 Medisch Spectrum Twente, Enschede, Netherlands

11 Netherlands Cancer Institute, Amsterdam, Netherlands

12 St. Antonius Hospital, Nieuwegein, Netherlands

13 Cancer Center Amsterdam, Amsterdam, Netherlands|||Amsterdam UMC, Location Vrije Universiteit, Amsterdam, Netherlands

14 University Medical Center Utrecht, Utrecht, Netherlands|||St. Antonius Hospital, Nieuwegein, Netherlands

Summary

AI Generated

In a Dutch randomized trial of 98 patients with malignant gastric outlet obstruction, EUS-guided gastroenterostomy was superior to surgical gastrojejunostomy for time to solid oral intake (1 day versus 3 days, HR 2.21, p=0.0003) and non-inferior for reintervention rates.

Median time to solid oral intake was 1 day with EUS-GE versus 3 days with surgical gastrojejunostomy (hazard ratio 2.21, 95% CI 1.43 to 3.42, p=0.0003).
Reintervention rates for persistent or recurrent obstruction within six months were 10% for EUS-GE versus 12% for surgery (risk difference 1.6%, meeting non-inferiority with upper 90% CI limit of 8.9% below the 20% margin).
Clinical success (tolerating solid oral intake) was achieved in 96% of EUS-GE patients versus 80% of surgical patients (relative risk 1.20, 95% CI 1.03 to 1.39).
Median hospital stay was 1 day with EUS-GE versus 4 days with surgery (relative change 0.46, 95% CI 0.20 to 0.78).
Serious adverse events (Clavien-Dindo grade 3B or higher) occurred in 8% of EUS-GE patients versus 12% of surgical patients (relative risk 0.69, 95% CI 0.21 to 2.31).
The trial authors concluded that EUS-guided gastroenterostomy should be the preferred palliative treatment for malignant gastric outlet obstruction.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Gastric outlet obstruction is a common manifestation of advanced gastric, duodenal, and periampullary malignancies, severely affecting quality of life. Endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) may be superior to surgical gastroenterostomy (SGJ) as palliative treatment for this condition, but randomised trials are currently lacking.

Aims & Methods

We performed a multicenter, randomized controlled trial involving palliative patients with a malignant obstruction localized between the pylorus and the distal duodenum, randomizing them 1:1 to either EUS-GE or SGJ. The first co-primary superiority end point was time to solid oral intake. The second co-primary non-inferiority end point was persistent or recurrent obstructive symptoms for which a reintervention was required within six months after treatment. The predefined non-inferiority margin was 20%.

Results

From February 2022 to February 2024, 250 patients were screened in 12 participating hospitals in the Netherlands. Of the 98 enrolled patients, 48 were assigned to EUS-GE and 50 were assigned to SGJ. Median age was 69 versus 70 years and the most prevalent etiology was pancreatic cancer in 58% versus 50% in the EUS-GE group and SGJ group, respectively. Median time to oral intake was significantly shorter in the EUS-GE group compared to the SGJ group: 1 day versus 3 days (hazard ratio, 2.21, 95% CI, 1.43 to 3.42, p=0.0003). In the endoscopic group, 5 patients (10%) experienced persistent or recurrent obstructive symptoms requiring reintervention, compared with 6 patients (12%) in the surgical group (risk difference, 1.6%, upper limit of 90% CI, 8.9%). Clinical success, defined as the ability to tolerate solid oral intake, was higher in the EUS-GE group (96% versus 80%, relative risk, 1.20, 95% CI, 1.03 to 1.39). Median length of hospital stay was shorter in the EUS-GE group (1 day versus 4 days, relative change, 0.46, 95% CI, 0.20 to 0.78). Serious adverse events, defined as Clavien-Dindo ≥3B, were observed in 8% of patients in the EUS-GE group and in 12% of patients in the SGJ group (relative risk, 0.69, 95% CI, 0.21 to 2.31). Median survival was 91 days after EUS-GE (95% CI, 74 to 140) and 74 days (95% CI, 46 to 110) after SGJ. Thirty-day mortality was 13% in the EUS-GE group and 26% in the SGJ group (relative risk, 0.48, 95% CI, 0.20 to 1.14). In the first three months following the procedure, quality of life was not different between the two treatments.

Conclusion

This trial showed that EUS-GE, compared to SGJ, is superior in terms of time to solid oral intake and non-inferior with regards to the rate of persistent or recurrent obstructive symptoms requiring reintervention. Based on these results, EUS-GE should be the preferred palliative treatment for malignant gastric outlet obstruction.

Disclosure

Yorick L. van de Pavert, Janine B. Kastelijn, Marc G. Besselink, Dieke C. Booij, Jurjen J. Boonstra, Judith Boot, Olivier R.C. Busch, Wouter J.M. Derksen, Bas Groot Koerkamp, Akin Inderson, Wim J. Lammers, Daan J. Lips, J. Sven D. Mieog, I. Quintus Molenaar, Alexander A.F.A. Veenhof, Niels G. Venneman, Robert C. Verdonk, Paco M.J. Welsing, Thomas R. de Wijkerslooth, and Hjalmar C. van Santvoort report no conflicts of interest.
Freek Daams is proctor for Intuitive, received educational grants from Medtronic, and received speaker’s fees from Johnson & Johnson and Medtronic.
Paul Fockens is consultant for Cook Endoscopy and Olympus.
Rogier P. Voermans reports research grants from Boston Scientific and Prion Medical, performed as a consultant for Boston Scientific and Cook Medical, and received speaker’s fees from Mylan and Zambon.
Roy L.J. van Wanrooij is a consultant for Boston Scientific.
Marco J. Bruno is a consultant for Boston Scientific, Cook Medical, and Pentax Medical; received support for industry-initiated studies from Boston Scientific and Cook Medical; and received support for investigator-initiated studies from Boston Scientific, Cook Medical, Pentax Medical, Mylan, Interscope, and ChiRhoStim.
Jeanin E. van Hooft received lecture fees from Cook Medical, Boston Scientific, Medtronic, and Abbvie, is an independent observer for Olympus, and is the current secretary general of the federation United European Gastroenterology (UEG).
Leon M.G. Moons is a consultant for Boston Scientific.
Frank P. Vleggaar is a consultant for Boston Scientific.

Event

UEG Week Berlin 2025

Topics

Immunology Oesophagus

Submission format

Abstract

Session

Opening Plenary

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Sebastian Stefanovic

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

UEG Journal Best Paper Award

Malte Buchholz

UEG Week 2025: Top Abstract Awards

I do underwater resection

Michael John Bourke

Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman

UEG Standards and Guidelines

Consensus

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Enrico Palmeri, Sebastian Stefanovic

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Guideline

ABSTRACT

Background and Aim

Direct cholangioscopy and pancreatoscopy have become widely implemented techniques in the diagnostic and therapeutic algorithms of several pancreaticobiliary disorders. This study aimed to generate general and indication-specific European consensus recommendations on cholangioscopy and pancreatoscopy.

Methods

Supported by the available literature, statements were formulated and grouped into the following categories: (1) pre-procedural considerations, (2) general technical aspects, (3) biliopancreatic stones, (4) biliary strictures, and (5) other indications. The evidence level of each statement was determined using the GRADE methodology. Cholangioscopy experts were invited to participate in a modified Delphi process. When 80% consensus was not reached, the statement was modified based on expert feedback and subjected to an additional Delphi round. Statements were rejected if they failed to reach consensus after three Delphi rounds.

Results

Thirty cholangioscopy experts completed the Delphi process. Forty-two (97.6%) generated statements were accepted, of which 39 (92.9%) in the first Delphi round. 12 statements on preprocedural and periprocedural settings, 8 statements on biliopancreatic stones, 13 statements on biliary strictures, and 9 statements on other indications were accepted.

Conclusion

Using a modified Delphi process, we developed general and indication-specific consensus recommendations for cholangioscopy to guide clinical practice.

Guideline

Consensus

Topics

Endoscopy Pancreas

Citation

United European Gastroenterology Journal, 2025; 13:1652–1667

Published

2025

More Like This:

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Sebastian Stefanovic

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

UEG Journal Best Paper Award

Malte Buchholz

UEG Week 2025: Top Abstract Awards

I do underwater resection

Michael John Bourke

Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman

UEG Podcast Episode

UEG Podcast

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Topics

Small Intestine & Nutrition

Published

2026

More Like This:

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Sebastian Stefanovic

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

UEG Journal Best Paper Award

Malte Buchholz

UEG Week 2025: Top Abstract Awards

I do underwater resection

Michael John Bourke

Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

UEG Journal Best Paper Award

Malte Buchholz 1

Affiliations

1 Uni Marburg, Marburg, Germany

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Event

UEG Week Berlin 2025

Topics

Nurses Pancreas Radiology & Imaging

Session

Hot topics in European gastroenterology

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Sebastian Stefanovic

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

UEG Journal Best Paper Award

Malte Buchholz

UEG Week 2025: Top Abstract Awards

I do underwater resection

Michael John Bourke

Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

UEG Week 2025: Top Abstract Awards

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Event

UEG Week Berlin 2025

Topics

Immunology

Session

Opening Plenary

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Sebastian Stefanovic

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

UEG Journal Best Paper Award

Malte Buchholz

UEG Week 2025: Top Abstract Awards

I do underwater resection

Michael John Bourke

Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

I do underwater resection

Michael John Bourke 1

Affiliations

1 Westmead Hospital Sydney, Westmead, Australia

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses

Session

Large controversies for large polyps

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Sebastian Stefanovic

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

UEG Journal Best Paper Award

Malte Buchholz

UEG Week 2025: Top Abstract Awards

I do underwater resection

Michael John Bourke

Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Breaking news in pancreatic care: The latest guidelines you can’t miss!

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman 1

Affiliations

1 Amsterdam UMC, Amsterdam, Netherlands

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Pancreas Standards & Guidelines

Session

From guidelines to clinical practice: Pancreatic lesions, PCN and acute pancreatitis

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Sebastian Stefanovic

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

UEG Journal Best Paper Award

Malte Buchholz

UEG Week 2025: Top Abstract Awards

I do underwater resection

Michael John Bourke

Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman

UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

Most popular content

Rate for better recommendations!