Background <p>Uncovered self-expanding metal stents (SEMS) are generally utilized for malignant gastric outlet obstruction (GOO), while fully covered, retrievable SEMS can be placed for benign GOO as an alternative to surgical treatment. In this real-world study, balloon dilation and SEMS were used to treat benign GOO.</p> Purpose <p>The purpose of this study was to examine the safety and efficacy of these two methods in benign GOO.</p> Methods <p>This real-world study was conducted in the interventional and gastroenterology department of our hospital between September 2019 and March 2025. Patients were admitted for benign GOO and entered into the study, with balloon dilation or SEMS placement to dilate strictures. The two treatments were compared in terms of length of hospital stay, treatment costs, techniques and clinical outcomes, complications, as well as the GOO scoring system (GOOSS).</p> Results <p>The technical success rates range from 76.5 to 87.1%. A significant increase in GOOSS was observed after procedure in all three groups, from GOOSS 1 to GOOSS 3 (<i>p</i> &lt; 0.05). Group A had the lowest incidence of complications (8.8%), while group B had the highest (38.7%, <i>p</i> = 0.0141), including 6 (19.4%) stent restenosis, 3 (9.7%) migration, and 2 (6.5%) stent fracture or obstruction. A total of 32 patients (48.5%) were clinically cured, with the highest clinical cure rate of 68.2% in the group A (<i>p</i> = 0.0389). Compared with group A, more hospitalization costs were observed in the group B and C (<i>p</i> = 0.0010). The number of treatment sessions, rate of stricture recurrence after first treatment, and duration of treatment were not statistically significant different in all three groups.</p> Conclusions <p>Balloon dilation and SEMS appear safe and effective for benign GOO. However, SEMS, associated with higher cost and more complications, are not recommended as first choice for the management of benign GOO compared to balloon dilation.</p>