BACKGROUND AND AIMS: EUS-guided gastroenterostomy (EUS-GE) has emerged as an alternative to surgical gastrojejunostomy and endoluminal stenting for malignant gastric outlet obstruction (MGOO). Studies regarding factors associated with the EUS-GE outcomes are limited. METHODS: A retrospective observational study was conducted with consecutive patients who underwent EUS-GE for MGOO from January 2016 to November 2023. Primary outcomes were technical success (establishing EUS-GE) and clinical success (low-residue diet tolerance without re-intervention at 90-day follow-up). Secondary outcomes were adverse events (AEs), reinterventions, and full regular diet tolerance. RESULTS: Technical success and clinical success rates were 92.70% (127 of 137) and 88.00%, respectively, with 42.86% of the patients tolerating a regular diet. Patients with peritoneal carcinomatosis had lower odds of technical success (odds ratio [OR], .19
95% confidence interval [CI], .04-.93). Obstruction at the level of stomach, compared with duodenum, had lower odds of clinical success (OR, .06
95% CI, .006-.56). AE and reintervention rates were 14.17% and 8.66%. Nasogastric tube decompression before EUS-GE was associated with lower AE rates in multivariable analysis (OR, .32
95% CI, .11-.95). Prior GI surgery was associated with reintervention in multivariable analysis (OR, 4.09
95% CI, 1.02-16.45
P = .047). CONCLUSIONS: EUS-GE has high technical and clinical success rates, with many patients tolerating a regular diet. Routine nasogastric tube decompression should be considered to minimize AEs. MGOO at the level of the stomach is associated with lower clinical success rates. Extra care should be taken while performing EUS-GE in patients with peritoneal carcinomatosis. Prior GI surgery is a likely risk factor for reintervention.