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.