A randomized trial shows that endoscopic ultrasound-guided gastroenterostomy (EUS-GE) significantly improves outcomes for patients with malignant gastric outlet obstruction over traditional surgical gastrojejunostomy (SGJ).

• Primary endpoint success occurred in only 7.9% of EUS-GE patients compared to 38.9% for SGJ (risk difference -31.0%).
• Patients on EUS-GE advanced to a solid diet in a median of 2 days vs. 5 days for SGJ, with shorter hospital stays (3 days vs. 9 days).

EUS-GE also resulted in improved quality of life and lower treatment costs (approximately $33,934 vs. $51,437).

• These findings suggest that EUS-GE could be the preferred approach for palliation in this patient population, enhancing recovery and reducing healthcare costs.