{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:10:09Z","timestamp":1790691009275,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Stent misdeployment is the most critical adverse event (AE) during endoscopic ultrasound\u2010guided gastroenterostomy (EUS\u2010GE). This study aimed to identify predictors of misdeployment in EUS\u2010GE for malignant gastric outlet obstruction (mGOO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter observational study utilized a prospectively maintained registry of consecutive patients undergoing EUS\u2010GE for mGOO at 13 tertiary centers in Taiwan, with mixed retrospective\u2010prospective assessment of fluoroscopic morphology (FM) of the gastrointestinal tract near the ligament of Treitz (four types) and EUS morphology (EM) of the target bowel (three types). The primary outcome was the misdeployment. Multivariable analysis identified predictors of misdeployment and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between July 2020 and June 2025, 165 patients were enrolled. Technical and clinical success rates were 98.2% and 95.2%, respectively. Overall AE rate and misdeployment rates were 7.3% and 4.8%, respectively. Same\u2010session endoscopic salvage succeeded in 87.5% of misdeployment cases. EM type C (cross\u2010sectional bowel view) carried the highest misdeployment risk (33%) and was the sole independent predictor (adjusted odds ratio 16.9;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). FM provided essential complementary risk stratification; FM type II was more common among misdeployment cases (25.0% vs. 3.8%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.030). Implementation of a stepwise strategy in 2023\u2014prioritizing EM type A\/B, avoiding type C, and minimizing stomach\u2013bowel distance\u2014resulted in zero misdeployment. Independent predictors of poor survival included pancreatic cancer, malnutrition, poor performance status, ascites, metastasis, and misdeployment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Stent misdeployment is a significant complication adversely impacting survival. Utilizing integrated EM and FM risk stratification within a stepwise strategy can minimize misdeployment and optimize clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov: NCT07230665<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70235","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T13:01:47Z","timestamp":1784293307000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>EUS<\/scp>\n                    \u2010Guided Gastroenterostomy for Malignant Gastric Outlet Obstruction: Morphological Classification to Prevent Stent Misdeployment"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2136-1126","authenticated-orcid":false,"given":"Yu\u2010Ting","family":"Kuo","sequence":"first","affiliation":[{"name":"Division of Endoscopy, Department of Integrated Diagnostics &amp; Therapeutics National Taiwan University Hospital, National Taiwan University  Taipei Taiwan"},{"name":"Department of Internal Medicine, College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9534-4890","authenticated-orcid":false,"given":"Chi\u2010Ying","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Center for Digestive Medicine China Medical University Hospital, China Medical University  Taichung 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Hospital and, Chang Gung University College of Medicine  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiang\u2010Yao","family":"Shih","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kaohsiung Medical University Hospital  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung\u2010Chun","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Tri\u2010Service General Hospital, National Defense Medical University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheuk\u2010Kay","family":"Sun","sequence":"additional","affiliation":[{"name":"Division of Hepatology and Gastroenterology, Department of Internal Medicine Shin Kong Wu Ho\u2010Su Memorial Hospital  Taipei 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