Endoscopic or Surgical Gastroenterostom 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 (two randomized trials and eight 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.