Nunes Gonçalo, Fonseca Jorge, Barata Ana Teresa, Dinis-Ribeiro Mário, Pimentel-Nunes Pedro
Gastroenterology Department, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal.
CiiEM - Center for Interdisciplinary Research Egas Moniz, Monte da Caparica, Portugal.
GE Port J Gastroenterol. 2020 Apr;27(3):172-184. doi: 10.1159/000502981. Epub 2019 Oct 7.
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.
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.
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.
消化系统肿瘤是发病和死亡的主要原因之一。许多癌症患者无法维持经口进食并出现营养不良。作者旨在：回顾癌症患者营养支持的内镜、放射学和外科技术；根据所选技术探讨营养干预策略；并建立一个决策算法以确定特定肿瘤情况下的最佳方法。
这是一项基于使用PubMed和UpToDate对医学文献进行电子检索的叙述性非系统性综述。无法维持经口进食是头颈部（H&N）癌、食管肿瘤和恶性胃出口梗阻患者营养不良的主要原因。管饲、内镜支架和胃空肠吻合术是三种主要的营养选择。鼻饲管适用于短期肠内喂养。当预期肠内营养超过3 - 4周时，经皮内镜下胃造口术（PEG）是金标准，尤其适用于接受确定性放化疗的H&N肿瘤和食管癌患者。可考虑使用胃固定推送系统以避免癌细胞播散。当内镜途径不可行时，放射学和外科胃造口术是替代方法。幽门后营养适用于不耐受胃喂养的患者，可通过鼻肠管、带空肠延长管的PEG、经皮内镜下空肠造口术和外科空肠造口术实现。食管和肠道支架是姑息性技术，可使患者经口进食并提高生活质量。当肠道支架失败或预期生存期延长时，建议行外科或超声内镜引导下胃空肠吻合术。营养干预取决于所选技术。应在多学科基础上制定机构方案和决策算法以优化营养护理。
胃肠病学家在为癌症患者提供维持经口或肠内喂养的内镜技术营养支持方面发挥核心作用。选择最有效的技术必须考虑癌症类型、肿瘤治疗方案、营养目标和预期患者生存期。
