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.

中文翻译：

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食管癌放化疗患者的肠内营养和生活质量：鼻胃管，食管支架和造口管喂养的比较

背景和目标

这项研究前瞻性地招募了接受食管支架，鼻胃管（NGT）或空肠造口/胃造口术喂养的食管鳞状细胞癌患者，以比较化学放疗（CRT）期间营养状况和生活质量的变化。

方法

总共对81例患者进行了分析（支架7例；外科造口术26例； NGT 19例；口服摄入量29例）。尽管进行了药物治疗，但在CRT期间通过口服喂养吞咽困难或疼痛加剧时，插入了NGT。记录系列体重和每日麻醉需求。还评估了血清白蛋白水平和生活质量的变化。在比较NGT和预防性造口术喂养的亚组分析中，排除了造口术组中5例完全闭塞的患者。

结果

在CRT结束时，所有组的患者平均体重都有相似的下降，总体变化为–6.41％±5.21％。与其他组相比，支架组的CRT疼痛明显​​加重，白蛋白降低（–1.03±.9 mg / dL），生活质量下降。在亚组分析中，支架组的体重减轻明显更高，而NGT组的麻醉剂需求更高，生活质量稍差。空肠造口术后2天（7.7％）出现肠梗阻。其中有五名患者（23.8％）接受了预防性造口术的创造，并且几乎没有使用过。

结论

这些初步结果引起了人们的担忧，即在接受CRT的患者中，食管支架的使用可能不太合适。通过鼻腔或经皮途径进行管饲似乎在CRT期间是相当有效的，但两者都有其优点和缺点。我们建议进行仔细的内窥镜评估，以在CRT期间根据需要选择更适合NGT喂养的人群。