Nutritional Support with Endoluminal Stenting During Neoadjuvant Therapy for Esophageal Malignancy

Bower, Matthew; Jones, Warren T.; Vessels, Ben; Scoggins, Charles R.; Martin, Robert C.G.

doi:10.1245/s10434-009-0630-2

Cited by 58 publications

(44 citation statements)

References 33 publications

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“…Preoperative malnutrition and prognosis after neoadjuvant chemotherapy followed by subsequent esophagectomy with stenosis during preoperative chemotherapy has been shown effective in maintaining preoperative nutrition (18,19). In addition, ghrelin administration may help maintain body weight and minimize the deterioration of nutritional status during chemotherapy (20).…”

Section: Editorialmentioning

confidence: 99%

Preoperative malnutrition and prognosis after neoadjuvant chemotherapy followed by subsequent esophagectomy

Yoshida

Baba

2017

J. Thorac. Dis.

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Section: Editorialmentioning

confidence: 99%

Preoperative malnutrition and prognosis after neoadjuvant chemotherapy followed by subsequent esophagectomy

Yoshida

Baba

2017

J. Thorac. Dis.

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Section: Preoperative Evaluationmentioning

confidence: 99%

“…Patients with esophageal cancer who are obstructed or experiencing dysphagia will likely need assistance with nutrition pre-operatively during neoadjuvant therapy. Compared with enteral feeding with a feeding jejunostomy, oral alimentation after placement of a covered silicone stent results in better relief of dysphagia, higher performance status, better tolerance of chemoradiotherapy, and better quality of life (12)(13)(14).After completion of neoadjuvant chemoradiotherapy, restaging PET-CT should be performed to rule out progression of disease or metastasis. Patients who have persistent disease or show a complete or partial response based on the lesion's FDG avidity on PET-CT are scheduled for esophagectomy 6-10 weeks after completion of neoadjuvant therapy.…”

mentioning

confidence: 99%

Robotic esophagectomy

Broussard¹,

Evans²,

Wei³

et al. 2016

J. Vis. Surg.

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esophagectomy should be considered. If EMR is performed in the context of Barrett's esophagus, radiofrequency ablation (RFA) to promote regression of the Barrett's should also be considered. Patients with persistent high-grade dysplasia after attempted RFA should also be considered for esophagectomy. EquipmentThe Da Vinci Surgical System is currently the only FDAapproved robotic system for lung surgery. The surgeon sits at a console some distance from the patient who is positioned on an operating table in close proximity to the robotic unit with its four robotic arms. The robotic arms incorporate remote center technology, in which a fixed point in space is defined, and about it the surgical arms move so as to minimize stress on the thoracic or abdominal wall during manipulations. The small proprietary Endowrist instruments attached to the arms are capable of a wide range of high-precision movements. These are controlled by the surgeon's hand movements, via 'master' instruments at the console. The 'master' instruments sense the surgeon's hand movements and translate them electronically into scaled-down micro-movements to manipulate the small surgical instruments. Hand tremor is filtered out by a 6-Hz motion filter. The surgeon observes the operating field through console binoculars. The image comes from a manoeuvrable high-definition stereoscopic camera (endoscope) attached to one of the robot arms. The console also has foot pedals that allow the surgeon to engage and disengage different instrument arms, reposition the console 'master' controls without the instruments themselves moving, and activate electric cautery. A second optional console allows tandem surgery and training. Da Vinci currently offers both the Xi and Si systems. The Xi system is newer and features an overhead beam that permits rotation of the instrument arms, allowing for greater flexibility in terms of direction of approach of the robot to the patient. Compared to the Si, he Xi also has thinner instrument arms, longer instruments themselves, and the option to switch the camera to any arm/port. Preoperative evaluationThe preoperative evaluation is no different for robotic esophagectomy than for open or other forms of MIE. A history and physical exam focused on elements such as gastroesophageal reflux disease, Barrett's esophagus, achalasia and other motility disorders, prior surgeries, cardiac and pulmonary comorbidities, and functional status. Esophagoscopy should be performed to obtain the tissue diagnosis, rule out a synchronous secondary primary, as well as document location of tumor and presence of associated findings such as Barrett's esophagus. Bronchoscopy is necessary in all proximal and middle-third tumors to evaluate local airway invasion or a synchronous second primary. Endoscopic ultrasound locally stages the tumor by evaluating the depth of penetration and involvement of regional lymph nodes, also offering fine-needle aspiration biopsy of suspicious lymph nodes if necessary. PET-CT of the chest, abdomen, and pelvis fulfills the st...

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“…31 Covered esophageal stents may be temporarily placed to relieve dysphagia, whereas patients undergo neoadjuvant therapy, thereby acting as a bridge to surgery. [32][33][34][35] Both plastic [32][33][34] and metal stents 35 have been used for this indication, which is yet to be approved by the U.S. Food and Drug Administration. After successful stent placement, improvement in dysphagia scores and nutritional status was reported in almost all patients.…”

Section: Esophageal Stentsmentioning

confidence: 99%

“…Stent migration is a concern, particularly after initiation of neoadjuvant therapy, and has been reported in 24% to 46% of patients. [32][33][34][35] Elective removal of the stent has been attempted to reduce the migration risk. 36 …”

Section: Esophageal Stentsmentioning

confidence: 99%

Enteral stents

Varadarajulu¹,

Banerjee²,

Barth³

et al. 2011

Gastrointestinal Endoscopy

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The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2010 for articles related to enteral, esophageal, duodenal, and colonic stents. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

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Nutritional Support with Endoluminal Stenting During Neoadjuvant Therapy for Esophageal Malignancy

Cited by 58 publications

References 33 publications

Preoperative malnutrition and prognosis after neoadjuvant chemotherapy followed by subsequent esophagectomy

Preoperative malnutrition and prognosis after neoadjuvant chemotherapy followed by subsequent esophagectomy

Robotic esophagectomy

Enteral stents

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