{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:51:51Z","timestamp":1791589911427,"version":"4.3.4"},"reference-count":102,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"abstract":"<jats:p>Background\u2002Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) and related EUS-guided anastomoses are increasingly used for gastric outlet obstruction (GOO) and other complex gastrointestinal scenarios, but the indications, technical standards, and periprocedural care remain heterogeneous.<\/jats:p>\n                  <jats:p>Methods\u2002An international panel of 66 experts (i-EUS) developed statements using a structured modified Delphi process. Literature searches were performed up to 30 April 2025. Comparative PICO-framed questions with extractable evidence underwent structured evidence synthesis and GRADE assessment, whereas procedural, technical, and organizational statements were classified as consensus based. Consensus was predefined as \u2265\u200a85\u200a% agreement.<\/jats:p>\n                  <jats:p>Results\u2002Of 25 draft statements, 20 reached consensus and five did not. Six endorsed statements were GRADE based and 14 were consensus based. For malignant GOO, EUS-GE was recommended over duodenal stenting because of greater durability and fewer reinterventions, and suggested over surgical bypass because of comparable efficacy and fewer overall adverse events. Consensus-based statements addressed expert-center requirements, supervised training, catheter-based target-loop distension, freehand lumen-apposing metal stent (LAMS) deployment, fluoroscopy availability, antithrombotic management, refeeding, postprocedural imaging, recurrent obstruction, and misdeployment. Conditional recommendations addressed LAMS-diameter selection, selected benign GOO, EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE)\/EUS-directed transgastric interventions (EDGI) in Roux-en-Y gastric bypass (RYGB), and malignant afferent limb syndrome. No formal recommendation was issued for peritoneal carcinomatosis, routine tracheal intubation, antibiotic prophylaxis, EUS-directed entero-enterostomy (EDEE) in non-RYGB anatomy, or EUS-guided coloenterostomy.<\/jats:p>\n                  <jats:p>Conclusions\u2002These i-EUS recommendations provide a practical framework for EUS-GE and related anastomoses in expert settings. The evidence base remains limited, and prospective comparative studies are needed to refine patient selection, training requirements, and long-term outcomes.<\/jats:p>","DOI":"10.1055\/a-2948-2876","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T22:57:13Z","timestamp":1788217033000},"source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic ultrasound-guided gastroenterostomy: an international consensus on current and expanding indications, techniques, periprocedural care, and institutional requirements"],"prefix":"10.1055","author":[{"given":"Giuseppe","family":"Vanella","sequence":"additional","affiliation":[{"name":"Pancreatobiliary Endoscopy and EUS Division, IRCCS San Raffaele Scientific Institute, Milan, Italy"},{"name":"Gastroenterology, Vita-Salute San Raffaele University, Milan, 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