Nasogastric Tube Versus Surgical Enterostomy in Obstructed Esophageal Cancer: A Comparison of Time-to-Treatment, Costs, and Nutritional Outcomes.

Background

Locally advanced esophageal cancer often presents with dysphagia and malnutrition, necessitating enteral feeding during chemoradiotherapy (CRT). This study compares the outcomes of pretreatment nasogastric tube (NGT) versus surgical enterostomy (SE) feeding.

Methods

A retrospective cohort study was conducted at King Chulalongkorn Memorial Hospital evaluating 98 patients with high-grade obstruction. To minimize selection bias, propensity score matching was utilized. Primary outcomes analyzed included time to treatment, health care costs for intervention, complications associated with enteral access, and nutritional outcomes.

Results

This study evaluated 97 patients (NGT: n=78, SE: n=19). To account for baseline differences, propensity score matching was executed using T-stage and pretreatment BMI. NGT patients had a significantly shorter waiting time to start CRT (16.2 vs. 36.7 d, P=0.033, 95% CI: [1.72, 39.20]), a lower cost of enteral access (11,194 THB vs. 28,250 THB, P<0.001, 95% CI: [13,237.06, 20,058.26]), a shorter length of hospital stay (2.3 vs. 5.9 d, P<0.001, 95% CI: [2.06, 5.06]), and a higher rate of resuming oral intake posttreatment (68% vs. 15.8%, P=0.001, 95% CI: [1.55, 13.43]). Nutritional outcomes were comparable between both groups, while both cohorts experienced significant declines in body weight and prognostic nutritional index (PNI) during CRT and then recovered within 3 months of completing treatment. Key limitations of this study include a small sample size and potential selection bias from the retrospective design.

Conclusion

NGT feeding may be a favorable option compared to open enterostomy for obstructed esophageal cancer patients in a limited resource setting, enabling faster treatment initiation and lower health care costs without compromising nutritional outcomes.