Nutritional Status and the Outcomes of Endoscopic Stenting in Benign and Malignant Diseases of Esophagus

Overview

Journal Nutrients

Date 2023 Mar 29

PMID 36986253

Authors

Wojciech Dudzic

Cezary Platkowski

Marcin Folwarski

Jaroslaw Meyer-Szary

Karolina Kazmierczak-Siedlecka

Marcin Ekman

Tomasz Wojciechowicz

Marek Dobosz

Affiliations

Soon will be listed here.

Abstract

Background: Endoscopic stenting (ES) is a widely known method for palliative dysphagia treatment in esophageal strictures. Esophageal cancer is often associated with advanced malnutrition, which may increase the risk of complications of the procedure. The aim of this study was to evaluate complication rates and the impact of nutritional status on the outcomes of ES.

Patients And Methods: A single-center retrospective study was conducted at Copernicus Hospital in Gdańsk, Poland. Adult patients who underwent endoscopic stenting between February 2014 and December 2018 were included. The influence of patient characteristics (age, sex, indications for esophageal stenting, and location of stenosis) and nutritional status (BMI, NRS 2002, GLIM, and dysphagia score) on complication rates and survival were analyzed.

Results: Eighty-one patients (69% men) were enrolled in the study. In 69%, the indication for ES was malignancy (mainly esophageal cancer). The median dysphagia score significantly decreased from 2.8 to 0.6 after the procedure ( < 0.001). Complications were observed in 27% ( = 22) of the patients. Early complications were bleeding (2.5%), stent unexpansion (2.5%), and stent migration during the procedure (3.7%). There were no early fatal complications of the procedure. Late complications included: stent migration (6.2%), tissue overgrowth (6.2%), food impaction (2.2%), fistula formation (3.7%), bleeding (3.7%), and stent malposition (1.2%). A total of 76% of the participants scored ≥ 3 points in nutritional screening (NRS2002) and 70% were diagnosed with severe malnutrition (GLIM -stage 2). A stent diameter of < 2.2 cm compared with ≥ 2.2 was associated with a higher rate of migrations (15.5% vs. 2.5%). The median survival time in the malignant group was 90 days. Histopathological diagnosis and patients' nutritional status (BMI, NRS 2002, GLIM, and dysphagia score) had no significant effect on complication rates and survival after esophageal stent insertion.

Conclusions: Endoscopic stenting is a relatively safe procedure for the palliative treatment of esophageal strictures. Severe malnutrition, although common, does not affect the outcomes of the procedure.

References

Verschuur E, Repici A, Kuipers E, Steyerberg E, Siersema P . New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol. 2007; 103(2):304-12. DOI: 10.1111/j.1572-0241.2007.01542.x. View

Chandan S, Mohan B, Khan S, Bhogal N, Canakis A, Bilal M . Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis. Endosc Int Open. 2020; 8(7):E944-E952. PMC: 7297607. DOI: 10.1055/a-1164-6398. View

Dallal H, Smith G, Grieve D, Ghosh S, Penman I, Palmer K . A randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma. Gastrointest Endosc. 2001; 54(5):549-57. DOI: 10.1067/mge.2001.118947. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Homs M, Steyerberg E, Eijkenboom W, Tilanus H, Stalpers L, Bartelsman J . Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004; 364(9444):1497-504. DOI: 10.1016/S0140-6736(04)17272-3. View

Anandavadivelan P, Lagergren P . Cachexia in patients with oesophageal cancer. Nat Rev Clin Oncol. 2015; 13(3):185-98. DOI: 10.1038/nrclinonc.2015.200. View

Gray R, ODonnell M, Scott R, McGuigan J, Mainie I . Impact of nutritional factors on survival in patients with inoperable oesophageal cancer undergoing self-expanding metal stent insertion. Eur J Gastroenterol Hepatol. 2011; 23(6):455-60. DOI: 10.1097/MEG.0b013e3283469761. View

Diamantis G, Scarpa M, Bocus P, Realdon S, Castoro C, Ancona E . Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia. World J Gastroenterol. 2011; 17(2):144-50. PMC: 3020367. DOI: 10.3748/wjg.v17.i2.144. View

Turkyilmaz A, Eroglu A, Aydin Y, Kurt A, Bilen Y, Karaoglanoglu N . Complications of metallic stent placement in malignant esophageal stricture and their management. Surg Laparosc Endosc Percutan Tech. 2010; 20(1):10-5. DOI: 10.1097/SLE.0b013e3181cdebf4. View

10.

Nagaraja V, Cox M, Eslick G . 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(2):119-26. PMC: 3999625. DOI: 10.3978/j.issn.2078-6891.2014.007. View

11.

Van B, Thanh H, Thi H, Nguyen Le Tuan A, Dang Thi Thu H, Viet D . Nutritional Status and Feeding Regimen of Patients with Esophagus Cancer-A Study from Vietnam. Healthcare (Basel). 2021; 9(3). PMC: 8000479. DOI: 10.3390/healthcare9030289. View

12.

Madhusudhan C, Saluja S, Pal S, Ahuja V, Saran P, Dash N . Palliative stenting for relief of dysphagia in patients with inoperable esophageal cancer: impact on quality of life. Dis Esophagus. 2009; 22(4):331-6. DOI: 10.1111/j.1442-2050.2008.00906.x. View

13.

Shi K, Ji F . Prophylactic stenting for esophageal stricture prevention after endoscopic submucosal dissection. World J Gastroenterol. 2017; 23(6):931-934. PMC: 5311102. DOI: 10.3748/wjg.v23.i6.931. View

14.

Amdal C, Jacobsen A, Sandstad B, Warloe T, Bjordal K . Palliative brachytherapy with or without primary stent placement in patients with oesophageal cancer, a randomised phase III trial. Radiother Oncol. 2013; 107(3):428-33. DOI: 10.1016/j.radonc.2013.04.008. View

15.

Ahmed O, Bolger J, ONeill B, Robb W . Use of esophageal stents to relieve dysphagia during neoadjuvant therapy prior to esophageal resection: a systematic review. Dis Esophagus. 2019; 33(1). DOI: 10.1093/dote/doz090. View

16.

Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff S . ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2016; 36(1):49-64. DOI: 10.1016/j.clnu.2016.09.004. View

17.

Symonds C . The Treatment of Malignant Stricture of the OEsophagus by Tubage or Permanent Catheterism. Br Med J. 2010; 1(1373):870-3. PMC: 2534527. DOI: 10.1136/bmj.1.1373.870. View

18.

Verschuur E, Steyerberg E, Kuipers E, Siersema P . Effect of stent size on complications and recurrent dysphagia in patients with esophageal or gastric cardia cancer. Gastrointest Endosc. 2007; 65(4):592-601. DOI: 10.1016/j.gie.2006.12.018. View

19.

Mariette C, Gronnier C, Duhamel A, Mabrut J, Bail J, Carrere N . Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer: impact on oncologic outcomes. J Am Coll Surg. 2015; 220(3):287-96. DOI: 10.1016/j.jamcollsurg.2014.11.028. View

20.

Shao X, Qi X, Guo X . Esophageal Stent for Refractory Variceal Bleeding: A Systemic Review and Meta-Analysis. Biomed Res Int. 2016; 2016:4054513. PMC: 4969514. DOI: 10.1155/2016/4054513. View