Aims Both gastric outlet obstruction (GOO) and biliary obstruction may occur simultaneously in individual patients. Small series have suggested that double EUS-bypass is feasible. Our aim was to compare same-session double EUS-bypass to open surgical hepaticojejunostomy and gastrojejunostomy. Methods A tertiary single-center retrospective analysis was performed of all consecutive double EUS-procedures performed from 2018 to March 2021. Consecutive historical surgical controls were extracted from the institutional database. For EUS-guided gastroenterostomy the WEST-technique was used, whereas for biliary obstruction, EUS-guided hepaticogastrostomy, rendez-vous, choledocho-bulbostomy or antegrade stenting were allowed. Results In total (n=42), 12 patients (28.6%) were treated with EUS and 30 patients with surgery (71.4%). At baseline, EUS-treated patients showed a higher Charlson Comorbidity Index (9.0 vs. 6.5, p=0.011). Technical success was achieved in 91.7% of EUS-treated patients vs. 100% in the surgical group (p=1.000). Clinical success, defined as a GOOS score>2 and serum bilirubin decrease>50%, was achieved in 66.7% and 70.0% respectively (p=0.833). In the EUS group, median time to oral intake (1.0 vs. 6.0 day(s), p
