Gastric outlet obstruction (GOO) can result from benign and malignant causes. 1 Surgical gastroenterostomy has been the treatment of choice for patients with benign and malignant GOO with a good functional status. 2 Placement ofluminalself-expandablemetalstentsiscurrentlyaccepted as the endoscopic treatment of choice for malignant GOO because of its effectiveness and minimally invasive nature. 3 The main limitation of luminal stents is the high incidence of recurrent GOO resulting from tumor/tissue ingrowth/ overgrowth. 4 More recently, EUS-guided gastroenteros- tomy (EUS-GE) has emerged as an alternative to both luminal stent placement and surgical gastroenterostomy. 5-7 The advantages of EUS-GE include its less-invasive nature compared with surgery, its efficacy, and the low incidence of recurrent GOO in cancer patients in addition to maintain- ing nutrition. 8 We present 5 techniques of EUS-GE using a lumen-apposing metal stent (LAMS) (Video 1, available online at www.VideoGIE.org).
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