Effect of Percutaneous Endoscopic Gastrostomy (Peg) Tube Feeding on Nutritional Status in Patients Undergoing Chemoradiotherapy for Oesophageal Cancer

Aims Oesophageal cancer in advanced stages causes dysphagia and weight loss. Malnutrition further worsens with multimodal treatment. Our aim was to evaluate the impact of percutaneous endoscopic gastrostomy (PEG) placement in the nutritional status of patients with oesophageal cancer requiring chemoradiotherapy (CRT).

Methods Prospective study. Oesophageal cancer patients proposed to CRT (neoadjuvant/definitive) with dysphagia grade > 2 and/or weight loss > 10 % were submitted to PEG tube placement (pull method) before CRT. A stoma swab was obtained immediately after placement and sent for cytology; in surgical patients, the stoma was resected evaluated for tumour seeding. A matched historical cohort without PEG placement was used as control. Trial ACTRN12616000697482.

Results 29 patients included(intervention group,IG), compared to 30 patients(control group,CG). Groups were comparable (p > 0.05) – IG:male = 96.6 %, age = 65.14±8.66(50-79), squamous cell carcinoma = 89.7 %, stage III = 75.9 %, at diagnosis BMI = 22.1±3.9(16.0-30.8)Kg/m² and weight loss of 11.54±7.72 %.

In the CG, during CRT, 14(46.7 %) patients presented with dysphagia grade 3-4 and 12 required additional nutritional support: nasogastric tube feeding(n = 10), surgical gastrostomy(n = 1) and oesophageal dilation(n = 1). In the IG, 89.7 % used the PEG tube during CRT, exclusively in 51.7 %. Technical success: 100 %. Complications were mainly minor(n = 12,41.38 %), mostly late peristomal infections; 1 major complication (exploratory laparotomy due to suspected colonic interposition, not confirmed). No cytological or histological(n = 12) evidence of stoma tumour seeding.

Tab. 1 Main outcomes.

	IG(n = 28)	CG(n = 30)	p-value
Weight loss during CRT, %(median [IQR])	6.85 (2.57-10.70)	8.30(3.62-13.61)	0.289
6-months mortality after CRT or surgery,%	17.2	26.7	0.383
Perioperative complications	6 (54.5 %)	5 (55.6 %)	1.000
Unplanned hospital admissions	10 (34.5 %)	12 (40.0 %)	0.661

Conclusions Weight loss, hospital admissions, surgical complications and mortality were identical in oesophageal cancer patients referred for CRT, regardless of prophylactic PEG. However, half of the patients required exclusive enteral nutritional support throughout the course of CRT, making PEG tube placement an alternative to consider.

Citation: Lemos Garcia J, Vale Rodrigues R, Mão-de-Ferro S et al. eP27 EFFECT OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE FEEDING ON NUTRITIONAL STATUS IN PATIENTS UNDERGOING CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER. Endoscopy 2021; 53: S106.

Publication History

Article published online:
19 March 2021