Abstract
Malignant gastric outlet obstruction (MGOO) is associated with severe gastrointestinal symptoms and diminished quality of life. EUS–guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative to surgical gastrojejunostomy (SGJ). We performed a systematic review and meta-analysis comparing EUS-GE versus SGJ for MGOO. PubMed, Web of Science, and the Cochrane Library were searched from inception through November 2025 for studies evaluating EUS-GE versus SGJ in adults with MGOO. Primary outcomes were technical and clinical success. Secondary outcomes included reintervention, overall adverse events (AEs), major AEs, and length of stay. Random-effects meta-analyses were performed. Eleven studies comprising 1223 patients (724 EUS-GE; 499 SGJ) were included. Technical success was high in both groups (94.8% vs. 97.3%; risk ratio [RR]: 0.99, P = 0.07). Clinical success was similar overall (93.4% vs . 87.8%; RR: 1.05, P = 0.075). Reintervention rates were numerically lower with EUS-GE (7.6% vs . 13.0%; RR: 0.60, P = 0.26). EUS-GE was associated with fewer overall AEs (RR: 0.42, P < 0.001) and major AEs (RR: 0.48, P = 0.014), and shorter length of stay (standardized mean difference: −1.19, P < 0.001). EUS-GE provides efficacy comparable to SGJ with lower AEs and shorter hospitalization, supporting its role as a minimally invasive option for MGOO in experienced centers.