Introduction: Malignant gastric outlet obstruction (GOO) is a debilitating complication of advanced gastrointestinal and pancreatobiliary cancers, leading to nausea, vomiting, poor oral intake, malnutrition, and impaired quality of life. Palliation aims to restore enteral intake rapidly while minimizing complications, hospital stay, and need for repeat procedures.
Introduction:
Malignant gastric outlet obstruction (GOO) is a debilitating complication of advanced gastrointestinal and pancreatobiliary cancers, leading to nausea, vomiting, poor oral intake, malnutrition, and impaired quality of life. Palliation aims to restore enteral intake rapidly while minimizing complications, hospital stay, and need for repeat procedures. Available options include enteral stenting, surgical gastrojejunostomy, stomach-partitioning gastrojejunostomy, and EUS-guided gastrojejunostomy (EUS-GJ).
Problem Statement:
Despite multiple available approaches, the optimal palliative strategy for malignant GOO remains uncertain. Enteral stenting is widely available and less invasive but may be limited by recurrent obstruction and need for reintervention. Surgical bypass offers durability but is associated with longer hospitalization and perioperative burden. Comparative evidence across all modalities has remained fragmented.
Summary:
This systematic review and network meta-analysis compared major treatment options for malignant GOO using randomized trial data. EUS-GJ emerged as the most favorable strategy, demonstrating superior clinical success compared with surgical gastrojejunostomy, stomach-partitioning gastrojejunostomy, and enteral stenting. Importantly, technical success and severe adverse events were broadly comparable across approaches, suggesting that the advantage of EUS-GJ lies mainly in more durable symptom relief rather than increased procedural risk. Enteral stenting remained an important alternative because it is less invasive, widely available, and generally less expensive; however, it carried a substantially higher need for reintervention, reflecting the risk of stent dysfunction or recurrent obstruction. Surgical approaches were associated with longer hospital stay, which may be particularly relevant in patients with limited life expectancy or poor performance status. Overall, the findings support EUS-GJ as the preferred palliative treatment for malignant GOO when local expertise is available. Treatment selection should still be individualized based on expected survival, tumor anatomy, procedural expertise, patient fitness, and resource availability.
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