Background: Although surgical treatments such as gastrojejunostomy is the standard palliative treatment for unresectable gastric cancer with gastric outlet obstruction (GOO), self-expandable metallic stent (SEMS) placement has been recently accepted as palliative therapy for those. Chemotherapy for advanced gastric cancer has been positively performed because new drugs such as S-1, irinotecan and taxanes show high response rates. However, data are lacking for chemotherapy after SEMS insertion. This study retrospectively compared results between surgery plus chemotherapy and stenting plus chemotherapy for metastatic gastric cancer with GOO. Patients and Methods: Subjects comprised 26 patients who received chemotherapy after surgery or endoscopic stenting for metastatic gastric cancer with pyloric stenosis between April 2000 and December 2007 in 4 Japanese hospitals. Patients were categorized into 2 groups: 15 patients who underwent surgery for pyloric stenosis and received chemotherapy (Surgery group); and 11 patients with SEMS placement for pyloric stenosis who received chemotherapy (Stent group). Results: No significant differences were noted between Surgery and Stent groups in terms of gender ratio, median age, PS, histological type, location and number of metastases, first-line chemotherapeutic regimen and number of chemotherapeutic regimens used. Median survival time and median time to treatment failure (TTF) were 284 days and 226 days in the Surgery group and 337 days and 247days in the Stent group, respectively. No significant differences were noted between in survival and TTF. No significant differences were found in median oral intake rate (Surgery, 93.1%; Stent, 93.2%) or median hospital stay rate (Surgery, 24.6%; Stent, 23.7%) during survival. Response rate was 45.5% in the Surgery group and 50% in the Stent group, with no significant difference. Likewise, no significant differences were noted between groups for frequencies of toxicity or complications. Conclusions: The present results suggest that chemotherapy after stenting is as effective and safe as chemotherapy after surgery. Stents may replace surgery in combination therapy with chemotherapy for metastatic gastric cancer with GOO.