[Comment] Redefining palliation in malignant gastric outlet obstruction

The field of therapeutic endoscopic ultrasonography has undergone remarkable expansion over the past decade. Initially used for drainage of pancreatic fluid collections, therapeutic endoscopic ultrasonography now spans a wide array of pancreaticobiliary and gastrointestinal indications.1,2 Reflecting this growth, the European Society of Gastrointestinal Endoscopy issued its first guidelines on therapeutic endoscopic ultrasonography in 2022.3 One notable advance has been the ability to create anastomoses between luminal structures, either to access excluded segments—such as in endoscopic ultrasonography-directed transgastric and transenteric endoscopic retrograde cholangiopancreatography procedures—or to bypass obstructed segments in the setting of gastric outlet or small bowel obstruction.