Laparoscopic gastrojejunostomy provides superior recovery and lower morbidity compared with open surgery and endoscopic stenting in malignant gastric outlet obstruction: A real-world cohort study

INTRODUCTION: Malignant gastric outlet obstruction (MGOO) is a debilitating complication of advanced upper gastrointestinal and pancreatobiliary cancers. While endoscopic stenting offers rapid symptom relief, its long-term durability is limited. Surgical bypass, particularly laparoscopic gastrojejunostomy (Lap-GJ), has gained popularity due to its minimally invasive nature, yet comparative real-world data remain scarce. This study evaluates perioperative outcomes, complications, and short-term mortality of Lap-GJ compared with open gastrojejunostomy (Open-GJ) and endoscopic stent placement in a large tertiary-center cohort.
METHODS: A retrospective cohort study was conducted at Erzurum City Hospital, including 156 patients treated for MGOO between 2015 and 2024. Patients were categorized into Lap-GJ (n=62), Open-GJ (n=54), and endoscopic stent (n=40) groups. Primary outcomes were time to oral intake (liquid, soft, and full diet) and length of hospital stay. Secondary outcomes included early postoperative complications, reintervention rates, stent-related adverse events, and 30- and 90-day mortality. Statistical analyses utilized Python-based libraries, employing appropriate parametric and non-parametric tests.
RESULTS: Lap-GJ resulted in significantly faster dietary progression compared with Open-GJ (median liquid diet: 2 vs. 4 days; soft diet: 4 vs. 7 days). Patients undergoing stenting advanced even more rapidly (1 and 2 days, respectively). Length of stay was shortest after stenting (median 3 days), intermediate after Lap-GJ (6 days), and longest after Open-GJ (10 days). Open-GJ demonstrated the highest complication burden, including wound infections (18.5 percent), pulmonary complications (20.4 percent), and anastomotic leak (5.6 percent). Lap-GJ showed a markedly lower morbidity profile, whereas stent patients frequently required reintervention (30 percent), primarily due to migration or recurrent obstruction. Mortality increased stepwise across modalities, with 30-day mortality of 9.7 percent (Lap-GJ), 18.5 percent (Open-GJ), and 30 percent (stent). Ninety-day mortality remained lowest in the Lap-GJ group.
DISCUSSION AND CONCLUSION: Laparoscopic gastrojejunostomy provides substantial advantages over open surgery in terms of postoperative recovery and complication rates while offering more durable palliation compared with endoscopic stenting. These real-world findings support the preferential use of Lap-GJ in appropriately selected patients with MGOO, particularly those with adequate functional reserve and expected survival beyond the short term. Endoscopic stenting remains valuable for rapid palliation in patients with limited prognosis.

Keywords: Endoscopic stenting, gastrointestinal surgery, laparoscopic gastrojejunostomy, malignant gastric outlet obstruction, morbidity, mortality, open gastrojejunostomy, palliation