Improvement of serum albumin level and PNI during the first 1 month of the treatment significantly correlated with better DSS (<i>P</i> = 0.006, 0.01, respectively).<h4>Conclusions</h4>Given a high oral intake success rate, S-1-based chemotherapy using an ED tube can be a promising treatment option for large Stage IV GC with poor oral intake. The gene discussed is ALB; the disease is gastric cancer.