Role of Devine gastric partitioning in locally advanced gastric cancer: palliation and bridge to definitive care–protocol for a systematic review

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BACKGROUND: Gastric outlet obstruction syndrome (GOOS) is a clinically significant condition often associated with advanced malignancies, particularly gastric and pancreatic cancers. Management strategies focus on symptom relief, nutritional improvement and quality of life enhancement. Surgical gastrojejunostomy (GJ), especially laparoscopic GJ, is commonly recommended for patients with good functional status and life expectancy exceeding 2 months. The modified Devine partial stomach-partitioning gastrojejunostomy (PSPG) was introduced to address functional limitations of conventional GJ, including duodenogastric reflux and afferent loop syndrome. However, PSPG has not been widely adopted, and its role in malignant GOOS remains unclear.This systematic review aims to synthesise the available evidence on the application, functional outcomes and oncological implications of the modified Devine technique in malignant GOOS. METHODS AND ANALYSIS: This review follows Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The PICO framework was employed to define eligibility criteria, focusing on studies examining PSPG for malignant GOOS as palliative surgery or a bridge to resection. Literature searches were conducted across Medline, EMBASE, Cochrane Library, ClinicalTrials.gov and grey literature sources using a prospectively registered search strategy, between August and October 2025, following protocol submission. Two independent reviewers will screen articles, extract data and assess quality using the Newcastle-Ottawa Scale where applicable. Data will be synthesised narratively. ETHICS AND DISSEMINATION: As this study is a systematic review of published literature, formal ethical approval was not strictly required. In accordance with institutional policy, the protocol was submitted to the Institutional Review Board of Hospital Prof. Doutor Fernando Fonseca, which confirmed that the study met criteria for ethical exemption. Findings will be disseminated through peer-reviewed publication. REGISTRATION: This study is registered in PROSPERO (CRD42024593540). Search strategy is registered in searchRxiv https://doi.org/10.1079/searchRxiv.2025.00838. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024593540 SEARCH STRATEGY REGISTRATION: https://doi.org/10.1079/searchRxiv.2025.00838.

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