Risk-adjusted Precision Reconstruction in Gastric Outlet Obstruction: A Prospective Cohort Demonstrating Superior Composite Delayed Gastric Emptying Outcomes with Roux-En-Y Gastrojejunostomy

Background: Delayed gastric emptying (DGE) is the most common complication following palliative gastrojejunostomy (GJ) for gastric outlet obstruction. Whether roux-en-Y (RY) reconstruction offers a clinical edge over the loop configuration remains unclear. Materials and Methods: The prospective cohort study included 41 patients who received either RY ( n = 19) or loop ( n = 22) GJ. The main study endpoint consisted of composite DGE (ISGPS Grades A/B/C) within 30 days. The research used multivariable logistic regression to determine independent risk factors. Results: DGE occurred in 22% overall, significantly less with RY (5%) than loop (36%; P = 0.024). RY remained protective after adjustment (adjusted odds ratio: 0.10; P = 0.053), while malignancy and male sex increased risk. Length of stay and serious morbidity were similar across groups. Conclusions: RY-GJ may markedly reduce postoperative DGE without added morbidity. Despite promising findings, the small sample size and nonrandomized design warrant cautious interpretation. Further validation in randomized trials is needed before routine use.