Gastric outlet obstruction results from any disease process that either affects the stomach’s ability to perform peristalsis or causes a mechanical obstruction at the level of the pylorus and impedes gastric emptying. Key aspects to management include obtaining a focused history and physical exam to narrow a vast differential, while simultaneously resuscitating a patient who may be volume depleted with metabolic derangements due to severe vomiting. Persistent emesis leads to a hypochloremic, hypokalemic, metabolic alkalosis with paradoxical aciduria. Once stable, imaging and endoscopy are key to establishing a diagnosis. Consideration of conservative versus endoscopic versus surgical management for benign versus malignant causes of gastric outlet obstruction.