Benign gastric outlet obstruction: evolving strategies from surgery to endoscopic ultrasound-guided gastrojejunostomy

Benign gastric outlet obstruction (bGOO) presents a significant therapeutic challenge, with etiologies ranging from peptic strictures to complex postsurgical or inflammatory conditions. While surgery has historically offered durable outcomes, its morbidity in frail populations underscores the need for effective, less invasive alternatives. This review critically examines the current literature up to April 2025 on surgical, endoscopic, and endoscopic ultrasound-guided interventions for bGOO, evaluating technical success, clinical outcomes, recurrence rates, and adverse events. Endoscopic balloon dilation shows excellent efficacy in simple peptic strictures but has limited efficacy in anatomically complex cases. Fully covered self-expandable metal stents can provide temporary relief but are associated with significant migration risk. Among emerging techniques, endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) stands out by combining the anatomical efficacy of surgery with the minimal invasiveness of endoscopy. Recent studies report technical and clinical success rates exceeding 95%, with lower recurrence and complication rates compared to traditional approaches. Comparative data increasingly support EUS-GJ as the preferred option in refractory or high-risk patients. Tailoring treatment strategies based on etiology, anatomical complexity, and patient condition is essential. EUS-GJ is redefining the therapeutic landscape of bGOO, offering a minimally invasive and durable alternative to surgery in carefully selected cases.