Comparing Endoscopic Ultrasound vs Surgical Gastrojejunostomy for Management of GOO.

Exclusion Criteria

• •1. \< 18 years of age
• •2. ECOG \>2
• •3. Expected survival (determined by the treating oncologist) is less than 2 months.
• •4. Candidates for potential resection of the cancer and obstructed anatomical area (this includes patients with borderline resectable pancreatic cancer)
• •5. Peritoneal carcinomatosis with associated bowel obstruction on imaging or during laparoscopy
• •6. Large volume ascites (patients with moderate volume ascites may undergo IR guided drainage prior to randomization)
• •7. Anatomical factors that technically hinder EUS-GJ OR Surgical-GJ (diffuse tumor involvement in path of LAMS or surgery, surgically altered anatomy that interferes with the ability to perform an anastomosis etc)
• •8. Pregnancy