Endoscopic or Surgical Gastroenterostomy for Malignant Gastric Outlet Obstruction: A Systematic Review and Meta-analysis.

Background and study aims: Malignant gastric outlet obstruction (MGOO) is a debilitating condition requiring effective palliation. Surgical gastrojejunostomy (SGJ) has been the traditional standard but is associated with relevant morbidity. Endoscopic ultrasound–guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative, though comparative efficacy and safety remain incompletely defined. This systematic review and meta-analysis compared EUS-GE and SGJ for palliative management of MGOO. Methods: This review was registered in PROSPERO (CRD420261283768). MEDLINE, Embase, Cochrane CENTRAL, Scopus, and LILACS were searched from January 2015 to October 2025. Random-effects meta-analyses were performed using risk ratios for technical and clinical success, odds ratios for adverse events, serious adverse events, symptom recurrence, reintervention, and 30-day mortality, and mean differences for length of hospital stay. Prespecified subgroup and sensitivity analyses were conducted to assess the robustness of findings. Results: Ten studies (2 randomized trials and 8 observational studies) including 1,087 patients (659 EUS-GE, 428 SGJ) were analyzed. Technical success was comparable between groups. EUS-GE was associated with higher clinical success (RR 1.06; 95% CI 1.01–1.12), fewer overall AE (OR 0.35; 95% CI 0.22–0.56) and SAE (OR 0.52; 95% CI 0.28–0.93). EUS-GE resulted in lower symptom recurrence (OR 0.39; 95% CI 0.18–0.85) and shorter LOS (mean difference −4.11 days; 95% CI −5.29 to −2.92). Reintervention rates and 30-day mortality were similar. Conclusions: EUS-GE is a safe and effective minimally invasive alternative to SGJ for palliation of MGOO. These findings support the growing role of EUS-GE as a preferred palliative strategy in specialized centers.