Endoscopic ultrasound-guided gastroenterostomy for the treatment of malignant gastric outlet obstruction in a 3-year-old boy.

Background and Aims: Malignant gastric outlet obstruction (GOO) is an exceptionally rare and devastating condition in children, for which evidence-based management strategies are lacking. Although recent European guidelines endorse EUS-guided gastroenterostomy (EUS-GE) as an alternative to endoscopic stent placement and surgical gastroenterostomy in adults, its use in pediatrics is virtually unreported, to our knowledge. This absence of data leaves clinicians facing complex decision-making in profoundly challenging circumstances. We report on a pediatric case to illustrate the technical feasibility and potential clinical role of EUS-GE in malignant GOO. Methods: We describe stent placement during EUS-GE using the wireless EUS-GE simplified technique (WEST) in a 3-year-old boy with malignant GOO caused by recurrent abdominal neuroblastoma. Results: The procedure was technically and clinically successful, permitting resumption of oral intake and durable symptom control. The patient died 2 months later during palliative chemotherapy, without recurrence of GOO. Conclusions: This case highlights EUS-GE as a feasible palliative option for malignant GOO in highly selected pediatric patients. Given the rarity and severity of this condition, EUS-GE may be considered in expert centers with substantial experience in therapeutic EUS, underscoring the need for further reporting to inform future pediatric practice.