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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
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: 188 Days and 22.7 Hours
Core Tip

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.

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