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）是进展期胃癌或胰头癌引发的严重并发症，通过阻碍经口进食并引发严重胃肠道症状，显著损害患者生活质量。随着消化性溃疡病等良性病因的减少，恶性肿瘤目前占全球胃出口梗阻（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模式。治疗方法包括保守治疗、内镜下支架置入术、外科胃空肠吻合术（GJ）、胃分隔式胃空肠吻合术（SPGJ）以及内镜超声引导下胃肠吻合术（EUS-GE）。内镜下支架置入术虽能以微创方式快速缓解症状，但其再梗阻率较高。GJ和SPGJ等外科手术方案能提供更持久的姑息治疗效果，尤其适用于预期生存期较长的患者。SPGJ作为一种改良外科技术，与传统GJ相比，可降低胃排空延迟发生率，并可能改善术后经口进食及生存情况。EUS-GE是一种前景广阔的微创替代方案，兼具外科手术的持久性与内镜操作的效率优势，尽管其长期数据仍有限。治疗方案的选择应综合考虑患者体能状态、肿瘤特征、预后及机构资源。本系统性综述强调，需要通过个体化、多学科决策来优化MGOO患者的症状缓解、营养状况及总体预后。
Advances in Surgical Management of Malignant Gastric Outlet Obstruction
肿瘤(癌症)患者之家