Gastric outlet obstruction (GOO) is a clinical syndrome represented by an impediment to gastric emptying secondary to a mechanical obstruction of the upper tract of the digestive tube. Nowadays, the pathogenesis is mainly attributed to a malignant disease from gastric or pancreatic origin, and its onset in geriatric subjects should be interpreted as an important oncological warning bell. GOO is frequently the expression of a metastatic or locally advanced cancer for which only palliative treatments are possible. In this chapter, the authors discuss the different pathogenetic, clinical, and therapeutic aspects of GOO in the elderly and frail patient. Palliation of “malignant” GOO can be performed with endoscopic or surgical procedures. Gastrojejunostomy is reserved for patients with better prognosis and laparoscopy gains space as an effective technique and an alternative to “open” surgery. Co-morbidity, frailty, and metabolic changes induced by GOO expose older people to a greater risk of perioperative complications. The lesser trauma resulting from the use of laparoscopy with synergic interdisciplinary perioperative management is proposed with the intent to counter the increased risk of adverse perioperative outcomes.