Establishment of an enteral nutrition pathway for malignant esophageal obstruction using combined esophageal stenting and gastrostomy

Abstract

Malnutrition is common in patients with advanced esophageal cancer and is associated with poor outcomes. While esophageal stenting can relieve dysphagia, oral intake alone is often insufficient. Percutaneous endoscopic gastrostomy (PEG) provides reliable nutritional support but does not address obstructive symptoms. Data on the combined use of these approaches are limited. We retrospectively analyzed 16 patients with esophageal cancer who underwent combined esophageal stenting and PEG between January 2016 and December 2024, including 10 who underwent simultaneous procedures and 6 who underwent non-simultaneous procedures. Changes in serum albumin, hemoglobin, and Karnofsky Performance Status (KPS) scores from baseline to 1 month after treatment were analyzed. The mean age was 63.13 ± 10.36 years, and 75.0% of the patients were male. Tumors were located in the upper, middle, and lower esophagus in 18.8%, 50.0%, and 31.3% of patients, respectively, and 37.5% had an esophageal fistula. The median interval from diagnosis to combined endoscopic treatment was 131.5 days (interquartile range, 20.8–389.8 days). Technical success was achieved in all patients, with no procedure-related bleeding or gastrostomy-site infection. In the non-simultaneous group, the median interval between the two procedures was 6.5 days (range, 2–177 days). New or worsening pulmonary infection within 30 days after treatment occurred in 12.5% of patients. During follow-up, stent migration and restenosis occurred in 12.5% and 6.3% of patients, respectively. At 1, 3, and 6 months after treatment, 93.8%, 56.3%, and 18.8% of patients were alive. Among the 15 patients with paired assessments at baseline and 1 month, serum albumin levels were 33.65 ± 4.51 and 34.43 ± 4.89 g/L, hemoglobin levels were 103.93 ± 23.08 and 106.73 ± 22.01 g/L, and Karnofsky Performance Status scores were 70 (60–85) and 70 (65–80) at the two time points. No statistically significant between-group differences were observed in the changes in serum albumin, hemoglobin, or Karnofsky Performance Status scores (all P > 0.05). Combined esophageal stenting and PEG was technically feasible in patients with advanced esophageal cancer and malignant esophageal obstruction, providing relief of obstruction while establishing enteral nutrition access. This combined strategy may be considered an option for palliative treatment, although its effects on nutritional and functional outcomes require further investigation.