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As patients have unresectable disease, management is palliative and traditionally relies on surgical gastrojejunostomy (SGJ) or enteral stenting, both with limitations. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged, but its role remains uncertain. We conducted a systematic review and meta-analysis comparing EUS-GE with SGJ and enteral stenting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Pubmed, Embase, Scopus, and Cochrane were searched for eligible studies. Mean differences (MDs) and risk ratio (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistics and trial sequential analysis evaluated the cumulative evidence. Prespecified subgroup analyses were conducted for randomized controlled trials and propensity score-matched studies. Statistical analyses were performed using RStudio.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-two studies were included, comprising 22,211 and 1,479 patients in the EUS-GE vs SGJ and EUS-GE vs enteral stenting analysis, respectively. EUS-GE was associated with fewer infections (RR 0.46;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0137), overall postoperative complications (RR 0.38;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), including both major (RR 0.43;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0109) and minor complications (RR 0.35;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), and a reduced need for reintervention (RR 0.15;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) than SGJ, as well as higher clinical success (RR 1.11;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0003) compared with enteral stenting. SGJ showed higher technical success (RR 0.98;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>EUS-GE offers a safe and effective minimally invasive alternative for MGOO. Its growing evidence base supports its consideration as a preferred option in centers with appropriate expertise.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12864-9","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T19:24:26Z","timestamp":1778613866000},"page":"4573-4597","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic ultrasonography-guided gastroenterostomy versus conventional approaches for cancer-related malignant gastrointestinal outlet obstruction: a meta-analysis with trial sequential analysis"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9126-0821","authenticated-orcid":false,"given":"Ana Lu\u00edza Rocha Soares","family":"Menegat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5703-1687","authenticated-orcid":false,"given":"Brenda Luana Rocha Soares","family":"Menegat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9661-8539","authenticated-orcid":false,"given":"Clara Rocha","family":"Dantas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5788-7098","authenticated-orcid":false,"given":"Barbara Antonia Dups","family":"Talah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0623-8135","authenticated-orcid":false,"given":"Francisco Cezar Aquino","family":"de Moraes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"12864_CR1","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.21037\/jgo-24-738","volume":"15","author":"Q Dong","year":"2024","unstructured":"Dong Q, Huang M, Lai X (2024) Metastasis patterns and prognosis in patients with gastric cancer: a surveillance, epidemiology, and end results-based analysis. 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