Saleh A, Yessin A, Salva W, Batarseh M, El Khoury M, Nehme F. Endoscopic ultrasound-guided gastrointestinal anastomosis: Evolving applications in advanced therapeutic endoscopy. World J Gastroenterol 2026; 32(39): 120546 [DOI: 10.3748/wjg.120546]
Corresponding Author of This Article
Fredy Nehme, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10th Street, Indianapolis, IN 46202, United States. nehme.fredy@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Saleh A, Yessin A, Salva W, Batarseh M, El Khoury M, Nehme F. Endoscopic ultrasound-guided gastrointestinal anastomosis: Evolving applications in advanced therapeutic endoscopy. World J Gastroenterol 2026; 32(39): 120546 [DOI: 10.3748/wjg.120546]
World J Gastroenterol. Oct 21, 2026; 32(39): 120546 Published online Oct 21, 2026. doi: 10.3748/wjg.120546
Endoscopic ultrasound-guided gastrointestinal anastomosis: Evolving applications in advanced therapeutic endoscopy
Akrum Saleh, Ahmad Yessin, Wailea Salva, Mina Batarseh, Mandy El Khoury, Fredy Nehme
Akrum Saleh, Ahmad Yessin, Wailea Salva, Mina Batarseh, Department of Internal Medicine, Indiana University School of Medicine, Muncie, IN 47303, United States
Mandy El Khoury, Department of Medicine, University of Balamand, Beirut 100, Beyrouth, Lebanon
Fredy Nehme, Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Author contributions: Saleh A, Yessin A, Salva W, El Khoury M, and Batarseh M performed the literature search and wrote the manuscript; Nehme F provided supervision and critical revisions to the manuscript.
AI contribution statement: The authors used ChatGPT in a limited capacity during manuscript preparation. Its use was restricted to language polishing and preliminary brainstorming to help identify possible topics or angles for consideration before the manuscript was written by the authors. ChatGPT was not used to generate the manuscript’s main scientific content, conclusions, references, or final scholarly interpretation. All text, concepts, citations, and interpretations were independently reviewed, revised, and verified by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript. No portion of the Abstract, Introduction, Methods, Results, Discussion, or Conclusion was accepted as AI-generated text. AI tools were not involved in study design, data collection, data analysis, interpretation of results, or formulation of conclusions. No images, figures, or graphical elements in the manuscript were generated by AI.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Fredy Nehme, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10th Street, Indianapolis, IN 46202, United States. nehme.fredy@gmail.com
Received: March 1, 2026 Revised: May 1, 2026 Accepted: May 20, 2026 Published online: October 21, 2026 Processing time: 187 Days and 20 Hours
Abstract
Lumen-apposing metal stents (LAMSs) were primarily designed for endoscopic ultrasound (EUS) guided drainage of peripancreatic fluid collections and have since gained wide clinical acceptance for this indication. Off-label use of LAMS grew rapidly afterwards, and multiple reports demonstrated the efficacy and safety of EUS-guided gastrointestinal anastomosis (EUS-GIA) through transmural LAMS placement. Endoscopists have since used EUS to obtain biliary and pancreatic access in postsurgical anatomy, to bypass gastric outlet obstruction, and to decompress the afferent loop. EUS-GIA has since gained significant traction with increased uptake among endoscopists and may potentially become standard of care for many of these indications. However, procedural standardization remains an issue. In this narrative review we will cover the current indications, technique, outcomes, and evidence related to EUS-GIA.
Core Tip: Endoscopic ultrasound (EUS)-guided gastrointestinal anastomosis has emerged as a highly effective minimally invasive platform for managing complex obstructive and altered anatomy conditions, including malignant gastric outlet obstruction, endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass, and afferent loop syndrome. Recent randomized data support EUS-guided gastroenterostomy as an effective alternative to surgical bypass and duodenal stenting. EUS-directed transgastric ERCP demonstrates comparable technical success to laparoscopy-assisted ERCP with shorter procedural times. As device technology and standardization improve, EUS-guided gastrointestinal anastomosis is poised to become an integral component of advanced therapeutic endoscopy.
