Jeong Sang-Ho, Park Miyeong, Seo Kyung Won, Min Jae-Seok
Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon 51472, Republic of Korea.
Department of Anesthesiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea.
Cancers (Basel). 2025 Aug 4;17(15):2567. doi: 10.3390/cancers17152567.
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.
恶性胃出口梗阻（MGOO）是晚期胃癌或胰头癌引起的严重并发症，通过干扰经口摄入并引发严重胃肠道症状，显著损害患者的生活质量。随着消化性溃疡病等良性病因的减少，目前在全球范围内，恶性肿瘤占胃出口梗阻（GOO）病例的50-80%。本综述概述了MGOO的病理生理学、不断演变的流行病学及治疗方式。治疗方法包括保守治疗、内镜支架置入、外科胃空肠吻合术（GJ）、胃分隔胃空肠吻合术（SPGJ）以及内镜超声引导下胃肠吻合术（EUS-GE）。虽然内镜支架置入能以微创方式快速缓解症状，但再梗阻发生率较高。GJ和SPGJ等手术方式能提供更持久的姑息治疗，尤其适用于预期生存期较长的患者。SPGJ作为一种改良手术技术，与传统GJ相比，胃排空延迟的发生率降低，可能改善术后经口摄入量及生存期。EUS-GE是一种有前景的微创替代方法，兼具手术的持久性和内镜的高效性，不过长期数据仍然有限。治疗选择应考虑患者的体能状态、肿瘤特征、预后及机构资源。这一全面综述强调，对于MGOO患者，需要进行个体化的多学科决策，以优化症状缓解、营养状况及总体预后。
