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

https://doi.org/10.1016/j.gie.2017.11.030Get rights and content

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.

Section snippets

Study population

Incident ESCC patients who received neoadjuvant or definite CRT at Kaohsiung Medical University Hospital, a medical center in southern Taiwan, were prospectively recruited through the hospital cancer registry between April 2012 and August 2016. Only those with an initial performance status score of 0 to 2 according to the Eastern Cooperative Oncology Group system and feasible for CRT were recruited.

Patients all received upper endoscopy to determine the cancer location, length, and severity of

Results

In total, 98 incident ESCC patients planning on neoadjuvant or definite CRT were enrolled. As shown in Figure 1, 17 patients were excluded according to the exclusion criteria. In total, 81 patients were analyzed, all men. They were classified into 4 groups: SEMS (n = 7), feeding stomy (n = 26), NGT feeding (n = 19), and nonstented oral diet (n = 29). One patient had worse odynophagia and dysphagia during CRT but could not endure NGT despite successful insertion; it was removed within a day and

Discussion

Our preliminary results suggest that ESCC patients using SEMSs during CRT commonly had intense and prolonged chest pain, poorer QoL, and decreased albumin level compared with the other groups. This poorer outcome was despite no evidence of metastatic disease in patients stented compared with the other 3 groups in which 10% to 24% had more advanced M1 disease (Table 1). The 7 patients in the stent group were recruited between 2014 and early 2015 before a nested case-control study in Europe was

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. Research support for this study was provided to Dr. I-Chen Wu by the Taiwan Ministry of Science and Technology (grant no. MOST 105-2314-B-037-019-MY3), Kaohsiung Medical University Hospital (grant no. KMUH105-5R01), and Kaohsiung Medical University (KMU-KMUH Co-project of Key Research, grant no. KMU-DK 107008).

    See CME section, p. 159.

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    © 2018 by the American Society for Gastrointestinal Endoscopy