Endoscopic ultrasound-guided gastrointestinal anastomosis: Evolving applications in advanced therapeutic endoscopy

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.