A 48-year-old woman who had previously undergone laparoscopic Roux-en-Y gastric bypass presented with unintentional weight loss, oral intolerance, nausea, and vomiting. The patient had a history of chronic gastrojejunostomy (GJ) stenosis managed by surgical GJ revision; however, the revision GJ developed chronic stenosis (Fig. 1). Multiple endoscopic balloon dilations of the revised surgical GJ had been attempted without clinical success. Adjacent to the stenotic surgically revised GJ, we performed EUS-guided GJ creation using a 15-mm lumen-apposing metal stent (Boston Scientific, Marlborough, Mass, USA), which partially relieved the patient’s symptomatic gastric outlet obstruction.