Electroacupuncture (EA) may reduce the duration of postoperative ileus (POI) after laparoscopic gastrectomy for gastric cancer, though evidence is limited. We investigated the efficacy of EA in reducing POI duration and enhancing gastrointestinal (GI) recovery in patients undergoing laparoscopic surgery for gastric cancer.This multicenter randomized trial was conducted at seven hospitals in China, enrolling 585 participants who underwent laparoscopic resection for gastric cancer from October 27, 2021, to December 21, 2023. Participants received perioperative standard care and were randomized to four sessions of EA, four sessions of sham EA (SA), or standard care only. The primary outcome was the time to first flatus. Secondary outcomes included time to first defecation, dietary recovery, quality of life, postoperative mobilization, and duration of hospital stay.578 participants were in the full analysis set. EA exhibited a shorter time to first flatus compared with both SA and standard care, with differences of -12.96 hours (95% CI, -19.17 to -6.75; P <.001) and -24.46 hours (95% CI, -30.61 to -18.30; P < .001), respectively. Similarly, EA significantly reduced the time to first defecation: -15.41 hours (95% CI, -27.73 to -3.09; P = .007) versus SA; -24.66 hours (95% CI, -36.76 to -12.55; P < .001) versus standard care. Incidence of prolonged POI was significantly lower in the EA group than in the SA and standard care groups, with group differences of -0.41 (95% CI, -0.66 to -0.16; P < .001) and -0.56 (95% CI, -0.82 to -0.31; P < .001), respectively. No severe adverse events were reported.EA was superior to SA and standard care only for reducing POI duration and the risk of prolonged POI in patients undergoing laparoscopic gastrectomy for gastric cancer (Trial number: ChiCTR2100050660).Copyright © 2025 AGA Institute. Published by Elsevier Inc. All rights reserved.