Stents in patients with esophageal cancer before chemoradiotherapy: high risk of complications and no impact on the nutritional status

Abstract

Preoperative chemoradiotherapy is the standard of care for locally advanced esophageal cancer, causing persistent deterioration in the nutritional status. We performed a prospective study to evaluate the safety and efficacy of esophageal double-covered self-expandable metal stents in patients with esophageal cancer before chemoradiotherapy. The nutritional status and dysphagia were prospectively recorded. Eleven patients were included: eight were moderate and three were severely malnourished. After stent placement, dysphagia improved in all patients. With regard to complications, one patient developed an esophageal perforation that required urgent esophagectomy. Four patients presented stent migration. Three of these patients required enteral nutrition and none was submitted to surgery because of poor nutritional status. Of the other six patients, only four were operated upon. Stent placement presented a high complication rate and did not prevent weight loss or malnutrition. Other alternatives, including naso-gastric tube placement or endoscopic percutaneous gastrostomy or jejunostomy, should be considered.

The Impact of Preoperative Sarcopenia on Survival Prognosis in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer: A Systematic Review and Meta-Analysis

“…Allum et al (28) conclude that EC patients with nutritional risk should be given 10-14 days of nutritional support before operation. Several approaches have been used to nutritional support during neoadjuvant therapy including esophageal stenting, jejunostomy or gastrostomy, and nasogastric or nasojejunal feeding (42)(43)(44). These approaches may improve prognosis.…”

Comparison between gastrostomy feeding and self-expandable metal stent insertion for patients with esophageal cancer and dysphagia

“…In addition to dysphagia and anorexia, esophagitis and side effects from radiotherapy and chemotherapy compromise oral intake. Therefore, patients with esophageal cancer could have persistent deterioration in nutritional status even after dysphagia is improved by SEMS insertion [24]. PG feeding can be used in patients with dysphagia and head and neck cancer and esophageal cancer to stabilize or improve the patients’ nutritional status [25,26].…”

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

“…With respect to oesophageal self-expanding metal stents (SEMS), eight recent studies of demonstrated a risk of 0% significant haemorrhage within 7 days of insertion. [150][151][152][153][154][155][156][157] However, studies including delayed haemorrhage showed a risk of 9% in an RCT comparing small-diameter stents with large-diameter stents and an 8% risk in a large retrospective series of 997 patients. 158 159 Causes of haemorrhage included aorta-oesophageal fistula formation, and continued oozing from tumours.…”