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Nunes G, Fonseca J, Barata AT, et al. Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?. GE Port J Gastroenterol. 2019;27(3):172-184doi: 10.1159/000502981.
Nunes, G., Fonseca, J., Barata, A. T., Dinis-Ribeiro, M., & Pimentel-Nunes, P. (2020). Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?. GE Portuguese journal of gastroenterology, 27(3), 172-184. https://doi.org/10.1159/000502981
Nunes, Gonçalo, et al. "Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?." GE Portuguese journal of gastroenterology vol. 27,3 (2020): 172-184. doi: https://doi.org/10.1159/000502981
Nunes G, Fonseca J, Barata AT, Dinis-Ribeiro M, Pimentel-Nunes P. Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?. GE Port J Gastroenterol. 2020 Apr;27(3):172-184. doi: 10.1159/000502981. Epub 2019 Oct 07. PMID: 32509923; PMCID: PMC7250336.
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GE Port J Gastroenterol. 2020 Apr;27(3):172-184. doi: 10.1159/000502981. Epub 2019 Oct 07.

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?.

GE Portuguese journal of gastroenterology

Gonçalo Nunes, Jorge Fonseca, Ana Teresa Barata, Mário Dinis-Ribeiro, Pedro Pimentel-Nunes

Affiliations

  1. Gastroenterology Department, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal.
  2. CiiEM - Center for Interdisciplinary Research Egas Moniz, Monte da Caparica, Portugal.
  3. Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.
  4. Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.

PMID: 32509923 PMCID: PMC7250336 DOI: 10.1159/000502981

Abstract

BACKGROUND: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting.

SUMMARY: This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care.

CONCLUSIONS: Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.

Copyright © 2019 by S. Karger AG, Basel.

Keywords: Cancer; Endoscopy; Gastrointestinal obstruction; Nutrition

Conflict of interest statement

The authors have no conflicts of interest to declare.

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