The Dutch ENDURO study, led by UMC Utrecht, shows that an endoscopic treatment for patients with a gastric outlet obstruction caused by cancer is just as effective as traditional surgery. In addition, patients recover faster and can go home sooner. The results were recently published in the leading journal The Lancet Gastroenterology & Hepatology.
A gastric outlet obstruction often occurs in patients with pancreatic cancer, duodenal cancer, or cancer at the junction between the stomach and small intestine. The condition can cause severe symptoms that greatly affect quality of life, such as vomiting, nausea, and inability to eat.
Traditionally, doctors have treated this problem with a surgical gastroenterostomy, creating a connection between the stomach and the small intestine so that food can pass through again. “Although this operation is effective in the long term, patients often experience many symptoms right after surgery, and it can take weeks for the stomach and intestines to recover”, explains Professor Frank Vleggaar, gastroenterologist at UMC Utrecht and lead investigator of the study. In addition to Frank Vleggaar, the study was co-established by Leon Moons (gastroenterologist UMC Utrecht), Hjalmar van Santvoort (surgeon UMC Utrecht), and Janine Kastelijn (PhD candidate).
For about ten years, a less invasive endoscopic technique has been available. Using a flexible tube with a camera (endoscope) and ultrasound guidance, doctors can create a new connection between the stomach and intestine without major surgery. “Patients seem to be able to eat sooner and recover faster after this procedure”, says Vleggaar. “But until now, the two treatments had never been compared directly.”
The ENDURO study, carried out in twelve hospitals across the Netherlands, compared the endoscopic treatment with traditional surgery in nearly one hundred patients.
On average, patients treated endoscopically were able to eat again after just one day, compared to three days for those who underwent surgery. “They could also go home sooner, which is important because these are patients who can no longer be cured and want to spend as much time at home as possible,” says Yorick van de Pavert, PhD candidate at UMC Utrecht.
When it comes to recurring symptoms or the need for additional procedures, the results were similar for both groups. However, a larger proportion of patients who received the endoscopic treatment were able to eat again at all. Vleggaar and Van de Pavert emphasize that the endoscopic treatment is very promising, provided it is performed by experienced specialists in hospitals that also perform major abdominal surgeries.
The ENDURO study recently won a Top Abstract Prize at UEG Week 2025, the largest European conference on gastroenterology and hepatology. It was selected as one of the five best studies out of more than 3,500 submissions. The €10,000 prize will be used for follow-up research, including studies on patients’ quality of life and the cost-effectiveness of the treatment.
Van de Pavert YL, Kastelijn JB, Besselink MG, et al. Endoscopic versus surgical gastroenterostomy for palliation of malignant gastric outlet obstruction (ENDURO): a randomised controlled trial. Lancet Gastroenterol Hepatol. Published online October 5, 2025.
