After potential subjects are screened from the physicians' schedules, they will be assessed for further inclusion criteria. They will be presented with the informed consent form for their review. Once they have been given the opportunity to review and ask questions, they will sign the consent form and from this point will be considered enrolled into the study.~After signing the informed consent, subjects will be randomized to one of the two cohorts in a 1:1 manner.~On the day of their assigned procedures, subjects will be asked several quality of life questionnaires to obtain a baseline status.~Data will be collected during and immediately following the procedure to assess for any possible adverse events.~Follow-up data will be completed at the following timepoints: 1-day, 2-day, 3-day, 4-day, and 7-day, 30-day, 3-month, 6-month, and 1-year post-procedure.~QOL Scoring Systems GOOSS- Gastric Outlet Obstruction Symptom Score~1 Inadequate or no oral intake~2 Liquids/thickened liquids~3 Semisolids/ low residue~4 unmodified~GFS- Gut Function Score from Lowe et al 2002~0 Profuse vomiting~1 Nausea and occasional vomiting~2 Nausea only~3 Normal gut function~Pre-Procedure Variables to Record Demographic~Gender~Weight~BMI~Cancer Type~Clinical Parameters~GOOSS~Gut Function Score~Karnofsky Performance Scale~Procedural Parameters~EUS-GJ: presence of ascites, able to pass scope beyond obstruction, use of wire to stabilize position, Length of procedure, intraprocedural AEs, Stent size used, successful completion of procedure~Laparoscopic GJ: presence of ascites, length of procedure, intraprocedural AEs, conversion to open GJ, successful completion of procedure~Post-procedure Hospitalization Daily Function~GOOSS~Gut Function Score~Time to initiation of oral intake liquids~Time to initiation of oral intake solids~Time to discharge~Post procedural AEs~30 Day Outcomes~GOOSS~Gut Function Score~Karnofsky Performance Scale~Weight/BMI~Able to tolerate TB approved chemotherapeutic regimen
Gastric outlet obstruction (GOO) occurs commonly in malignancies involving the periampullary region (cancers originating in the head of the pancreas, duodenum, bile duct, or ampulla) or the distal stomach. GOO not only causes debilitating symptoms such as nausea, vomiting, inability to tolerate oral intake, and prevents adequate nutritional intake. Therefore, providing therapy for GOO is imperative to improve the quality of life, and nutritional status of these patients, as well as allow them to continue receiving their cancer treatment