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Review
. 2025 Aug 4;17(15):2567.
doi: 10.3390/cancers17152567.

Advances in Surgical Management of Malignant Gastric Outlet Obstruction

Sang-Ho Jeong  1 , Miyeong Park  2 , Kyung Won Seo  3 , Jae-Seok Min  4   5
Affiliations
Review

Advances in Surgical Management of Malignant Gastric Outlet Obstruction

Sang-Ho Jeong et al. Cancers (Basel). .

Abstract

Malignant gastric outlet obstruction (MGOO) is a serious complication arising from advanced gastric or pancreatic head cancer, significantly impairing patients' quality of life by disrupting oral intake and inducing severe gastrointestinal symptoms. With benign causes such as peptic ulcer disease on the decline, malignancies now account for 50-80% of gastric outlet obstruction (GOO) cases globally. This review outlines the pathophysiology, evolving epidemiology, and treatment modalities for MGOO. Therapeutic approaches include conservative management, endoscopic stenting, surgical gastrojejunostomy (GJ), stomach partitioning gastrojejunostomy (SPGJ), and endoscopic ultrasound-guided gastroenterostomy (EUS-GE). While endoscopic stenting offers rapid symptom relief with minimal invasiveness, it has higher rates of re-obstruction. Surgical options like GJ and SPGJ provide more durable palliation, especially for patients with longer expected survival. SPGJ, a modified surgical technique, demonstrates reduced incidence of delayed gastric emptying and may improve postoperative oral intake and survival compared to conventional GJ. EUS-GE represents a promising, minimally invasive alternative that combines surgical durability with endoscopic efficiency, although long-term data remain limited. Treatment selection should consider patient performance status, tumor characteristics, prognosis, and institutional resources. This comprehensive review underscores the need for individualized, multidisciplinary decision-making to optimize symptom relief, nutritional status, and overall outcomes in patients with MGOO.

Keywords: endoscopy; gastric outlet obstruction; gastrojejunostomy; palliative management; quality of life; stomach neoplasm; surgery.

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Conflict of interest statement

The authors declare no conflicts of interest for this article.

Figures

Figure 2
Figure 2
Treatment modalities for palliation of malignant gastric outlet obstruction (MGOO, Malignant Gastric Outlet Obstruction).
Figure 3
Figure 3
Determining the appropriate treatment for patients with gastric outlet obstruction.
Figure 1
Figure 1
Endoscopic (A,B), surgical (C) findings, and computed tomography image (D) of malignant gastric outlet obstruction.
See this image and copyright information in PMC

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