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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.<\/jats:p>","DOI":"10.1177\/26317745251398950","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T13:47:39Z","timestamp":1773236859000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Benign gastric outlet obstruction: evolving strategies from surgery to endoscopic ultrasound-guided gastrojejunostomy"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9335-6740","authenticated-orcid":false,"given":"Giacomo Emanuele Maria","family":"Rizzo","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4265-259X","authenticated-orcid":false,"given":"Giuseppe","family":"Infantino","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Endoscopy Service, IRCCS \u2013 ISMETT, Via Tricomi 5, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Rancatore","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dario","family":"Quintini","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dario","family":"Ligresti","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicoletta","family":"Belluardo","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elio","family":"D\u2019amore","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Giacchetto","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Tarantino","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Services, Gastroenterology and Endoscopy Unit, Istituto Mediterraneo dei Trapianti e Terapie ad Alta Specializzazione, ISMETT-IRCCS, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.86a.18035"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.5505\/ejm.2021.47354"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.5009\/gnl210327"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15225367"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13213308"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1309382"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2025.03.012"},{"key":"e_1_3_4_9_2","article-title":"Italian association of hospital gastroenterologists and endoscopists (AIGO) and the endorsement of Italian association for the study of the pancreas (AISP). 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