Impact of Percutaneous Endoscopic Gastrostomy Tube Feeding on Nutritional Status in Patients Undergoing Chemoradiotherapy for Oesophageal Cancer

Abstract

<b><i>Introduction:</i></b> Oesophageal cancer causes dysphagia and weight loss. Malnutrition further worsens with multimodal treatment. <b><i>Aim:</i></b> The aim of the study was to evaluate the impact of percutaneous endoscopic gastrostomy (PEG) placement in the nutritional status of patients with oesophageal cancer requiring chemoradiotherapy (CRT). <b><i>Methods:</i></b> A comparative study with a prospective arm and a historical cohort was conducted. Oesophageal cancer patients undergoing CRT with dysphagia grade &#x3e;2 and/or weight loss &#x3e;10% were submitted to PEG-tube placement (pull method) before CRT. Stoma seeding was evaluated through a swab obtained after placement and, in surgical patients, the resected stoma. A matched historical cohort without PEG placement was used as control (trial ACTRN12616000697482). <b><i>Results:</i></b> Twenty-nine patients (intervention group, IG) were compared to 30 patients (control group, CG). Main outcomes did not differ in the IG and CG: weight loss during CRT 8.1 ± 5.5 kg versus 9.1 ± 4.2 kg (<i>p</i> = 0.503); 6-month mortality after CRT or surgery 17.2% versus 26.7% (<i>p</i> = 0.383); perioperative complication rate 54.5% versus 55.6% (<i>p</i> = 1.000); unplanned hospital admissions 34.5% versus 40.0% (<i>p</i> = 0.661). In the CG, during CRT, 14 (46.7%) patients presented with dysphagia grade 3–4, of whom 12 required nasogastric tube feeding (<i>n</i> = 10), surgical gastrostomy (<i>n</i> = 1), and oesophageal dilation (<i>n</i> = 1). In the IG, 89.7% used the PEG tube during CRT, sometimes exclusively in 51.7%. Adverse events were mainly minor (<i>n</i> = 12, 41.4%), mostly late peristomal infections, 1 major complication (exploratory laparotomy due to suspected colonic interposition, not confirmed). There was no cytological or histological evidence of stomal tumour seeding. <b><i>Conclusion:</i></b> 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, making PEG-tube placement an alternative to consider.