Efficacy of endoscopic ultrasound-guided versus surgical gastrojejunostomy for malignant gastric outlet obstruction: a systematic review and meta-analysis

Objective To systematically compare the key outcomes of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) versus surgical gastrojejunostomy (SGJ) for the palliative treatment of malignant gastric outlet obstruction (MGOO). Methods A systematic review and meta-analysis was conducted in accordance with the PRISMA statement. Databases including PubMed, Embase, Web of Science and Cochrane Library were comprehensively searched from inception to December 2025 for comparative studies of EUS-GJ and SGJ in treating MGOO. Meta-analysis was performed using a random-effects model, with subgroup and sensitivity analyses. Results Eight studies involving 760 patients were included. Pooled analysis showed no significant differences between EUS-GJ and SGJ in technical success (RR = 0.98, P = 0.08), clinical success (RR = 1.08, P = 0.07), obstruction recurrence (RR = 0.48, P = 0.05), or re-intervention rates (RR = 1.48, P = 0.61). However, the EUS-GJ group demonstrated significant advantages, including a shorter length of hospital stay (MD= -3.57 days, P<0.001), a quicker time to first oral intake (MD= -2.88 days, P<0.001), a shorter time to resume chemotherapy (MD= -16.05 days, P<0.001), and a lower overall adverse events rate (RR = 0.44, P = 0.008). Conclusion For the palliative management of MGOO, EUS-GJ showed no statistically significant difference in primary efficacy endpoints compared with SGJ, but it might be associated with faster recovery and improved safety. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261308316.