Enteral nutrition and quality of life in patients undergoing chemoradiotherapy for esophageal carcinoma: a comparison of nasogastric tube, esophageal stent, and ostomy tube feeding

Published:December 07, 2017DOI:https://doi.org/10.1016/j.gie.2017.11.030

      Background and Aims

      This study prospectively recruited esophageal squamous cell carcinoma patients who received esophageal stent, nasogastric tube (NGT), or jejunostomy/gastrostomy feeding to compare the changes in nutritional status and quality of life during chemoradiation therapy (CRT).

      Methods

      In total, 81 patients were analyzed (stent, 7; surgical ostomy, 26; NGT, 19; oral intake, 29). An NGT was inserted when, despite medication, dysphagia or pain worsened with oral feeding during CRT. Serial body weight and daily narcotic demand were recorded. Changes in serum albumin level and quality of life were also assessed. In subgroup analysis comparing NGT and prophylactic surgical ostomy feeding, 5 patients with total occlusion in the ostomy group were excluded.

      Results

      Patients in all groups had similar decreases in mean body weight with an overall change of –6.41% ± 5.21% at the end of CRT. The stent group had significantly worse pain, decreased albumin (–1.03 ± .9 mg/dL), and decreased quality of life across CRT compared with the other groups. In subgroup analysis the stent group had significantly higher weight loss, whereas the NGT group had higher narcotic demand and slightly worse quality of life. Two patients (7.7%) had ileus days after jejunostomy creation. Five patients (23.8%) among those received prophylactic ostomy creation and scarcely used it.

      Conclusions

      These preliminary results raise concerns that use of esophageal stents may be less suitable in patients undergoing CRT. Tube feeding by means of transnasal or percutaneous routes appear to be comparably effective during CRT, but both have advantages and disadvantages. We suggest a careful endoscopic evaluation to select the population more appropriate for NGT feeding on an as-needed basis during CRT.

      Graphical abstract

      Abbreviations:

      ANOVA (analysis of variance), CRT (chemoradiation therapy), ESCC (esophageal squamous cell carcinoma), NGT (nasogastric tube), QoL (quality of life), SEMS (self-expandable metal stent)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bozzetti F.
        • Group S.W.
        Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients.
        Support Care Cancer. 2009; 17: 279-284
        • Rustgi A.K.
        • El-Serag H.B.
        Esophageal carcinoma.
        N Engl J Med. 2014; 371: 2499-2509
        • Pennathur A.
        • Gibson M.K.
        • Jobe B.A.
        • et al.
        Oesophageal carcinoma.
        Lancet. 2013; 381: 400-412
        • Evans J.A.
        • Early D.S.
        • Chandraskhara V.
        • et al.
        • ASGE Standards of Practice Committee
        The role of endoscopy in the assessment and treatment of esophageal cancer.
        Gastrointest Endosc. 2013; 77: 328-334
        • Spaander M.C.
        • Baron T.H.
        • Siersema P.D.
        • et al.
        Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
        Endoscopy. 2016; 48: 939-948
        • Jones C.M.
        • Griffiths E.A.
        Should oesophageal stents be used before neo-adjuvant therapy to treat dysphagia in patients awaiting oesophagectomy? Best evidence topic (BET).
        Int J Surg. 2014; 12: 1172-1180
        • Lin C.H.
        • Liu N.J.
        • Lee C.S.
        • et al.
        Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy.
        Gastrointest Endosc. 2006; 64: 104-107
        • Cooper J.S.
        • Guo M.D.
        • Herskovic A.
        • et al.
        Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group.
        JAMA. 1999; 281: 1623-1627
        • Wu I.C.
        • Wu C.C.
        • Lu C.Y.
        • et al.
        Substance use (alcohol, areca nut and cigarette) is associated with poor prognosis of esophageal squamous cell carcinoma.
        PLoS One. 2013; 8e55834
        • Ogilvie A.L.
        • Dronfield M.W.
        • Ferguson R.
        • et al.
        Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy.
        Gut. 1982; 23: 1060-1067
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Coates A.
        • Porzsolt F.
        • Osoba D.
        Quality of life in oncology practice: prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancy.
        Eur J Cancer. 1997; 33: 1025-1030
        • Blazeby J.M.
        • Conroy T.
        • Hammerlid E.
        • et al.
        Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer.
        Eur J Cancer. 2003; 39: 1384-1394
        • Mariette C.
        • Gronnier C.
        • Duhamel A.
        • et al.
        Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer: impact on oncologic outcomes.
        J Am Coll Surg. 2015; 220: 287-296
        • Nagaraja V.
        • Cox M.R.
        • Eslick G.D.
        Safety and efficacy of esophageal stents preceding or during neoadjuvant chemotherapy for esophageal cancer: a systematic review and meta-analysis.
        J Gastrointest Oncol. 2014; 5: 119-126
        • Bower M.
        • Jones W.
        • Vessels B.
        • et al.
        Nutritional support with endoluminal stenting during neoadjuvant therapy for esophageal malignancy.
        Ann Surg Oncol. 2009; 16: 3161-3168
        • Martin 2nd, R.C.
        • Cannon R.M.
        • Brown R.E.
        • et al.
        Evaluation of quality of life following placement of self-expanding plastic stents as a bridge to surgery in patients receiving neoadjuvant therapy for esophageal cancer.
        Oncologist. 2014; 19: 259-265
        • Langer F.B.
        • Schoppmann S.F.
        • Prager G.
        • et al.
        Temporary placement of self-expanding oesophageal stents as bridging for neo-adjuvant therapy.
        Ann Surg Oncol. 2010; 17: 470-475
        • Brown R.E.
        • Abbas A.E.
        • Ellis S.
        • et al.
        A prospective phase II evaluation of esophageal stenting for neoadjuvant therapy for esophageal cancer: optimal performance and surgical safety.
        J Am Coll Surg. 2011; 212 (discussion 8-9): 582-588
        • Jenkinson A.D.
        • Lim J.
        • Agrawal N.
        • et al.
        Laparoscopic feeding jejunostomy in esophagogastric cancer.
        Surg Endosc. 2007; 21: 299-302
        • Margolis M.
        • Alexander P.
        • Trachiotis G.D.
        • et al.
        Percutaneous endoscopic gastrostomy before multimodality therapy in patients with esophageal cancer.
        Ann Thorac Surg. 2003; 76 (discussion 7-8): 1694-1697
        • Choi A.H.
        • O'Leary M.P.
        • Merchant S.J.
        • et al.
        Complications of feeding jejunostomy tubes in patients with gastroesophageal cancer.
        J Gastrointest Surg. 2017; 21: 259-265
        • Shenfine J.
        • McNamee P.
        • Steen N.
        • et al.
        A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer.
        Health Technol Assess. 2005; 9 (1-121): iii
        • Cools-Lartigue J.
        • Jones D.
        • Spicer J.
        • et al.
        Management of dysphagia in esophageal adenocarcinoma patients undergoing neoadjuvant chemotherapy: Can invasive tube feeding be avoided?.
        Ann Surg Oncol. 2015; 22: 1858-1865
        • Huerter M.E.
        • Charles E.J.
        • Downs E.A.
        • et al.
        Enteral access is not required for esophageal cancer patients undergoing neoadjuvant therapy.
        Ann Thorac Surg. 2016; 102: 948-954

      Linked Article