Vomiting with a closed esophagus

I had the stent put in back in 2021. It was originally supposed to be the first thing done. It was postponed and I had been in chemo and radiation for a couple of weeks before it was done. It was the worst of my treatment and had to be taken out a week later, and a j tube put in place. Honestly I had issues with swallowing and vomiting was never a serious side effects until the stent. Hindsight stay with the feeding tube.

Thank you for your reply, Manz. So sorry you had to go through that. My mom just had her stent taken out and has the j-tube only now. She comes home after 3 weeks in hospital after what was supposed to be a simple outpatient procedure of putting the stent in. Hopefully she’ll get enough nourishment now to undergo her first radiation/chemo treatments. I hope you are doing well now. All the best!

Edward
I'm sorry to hear of your mother's struggles. One of the more problematic aspects of esophageal carcinoma is maintaining esophageal patency which may be reduced due stricture formation post-radiotherapy or tumor growth. Palliative remediation procedures like stenting or dilation are temporary and problematic, particularly stenting.

I am a 4+ year survivor of Stage 4 squamous cell esophageal carcinoma and have been dealing with total esophageal occlusion for >2 yrs. I refused stenting because they are highly problematic. They all will either shift in position, suffer cellular over-growth, may cause esophageal tears and perforations and general discomfort. It would appear that your mother has suffered than a few of these complications as have many other respondents to your query. I agree with those who recommend installation of either a a G-J or G tube. This should allow her to recieve adequate nutrition, hydration and most of her needed medications and supplements. I've had my G-tube in place for more than two years and it has allowed me to regain and maintain a healthy weight for my age and height ( 70 yo, 5'11", 155lbs). While not ideal, as long as you clean the area around the stoma and maintain the tubes patency via adequate flushing/cleaning, they work quite well.

I have occasional bouts of nausea but as I have total esophageal occlusion, I am unable to expell my gastic contents orally. This is most uncomfortable but I manage this with various anti-emetics such as odansetron or compazine. Benadryl, valium or cloapin are also useful adjunctive therapies for reducing anxiety and anticipatory nausea and vomiting. As I am unable to swallow my oral secretions I am constantly wretching into my yak bags which is a tad gross and embarrassing but you learn to live with it. I find that benadryl
or scopolamine patches help a bit with in controlling my excessive salivation. There are other drugs available but I don't use them.

In summary, I would recommend that your mother use a G-tube. She will be should be able to gain and maintain weight, stay hydrated and reduce her nausea and vomiting.

Sounds promising for your Mom that’s fantastic. I’ll take the j tube over the stent anyday. Hope for her fast recovery and have a great day!

I've posted a summary of a recent paper that appeared in this month's issue of Gastoenterology.

Written by Eric Montminy MD
Percutaneous endoscopic gastrostomy (PEG) tube placement has been frequently performed in patients with poor per os (PO) intake undergoing treatment for esophageal cancer. Dong et al presents a prospective analysis of different methods of nutritional intake involving 156 patients with esophageal squamous cell carcinoma (ESCC) scheduled to undergo chemoradiotherapy. The primary aim was to measure body weight and skeletal muscle index (low levels of both were associated with poorer prognosis) and determine which nutritional intake method (PO, PEG, or nasogastric tube) maintained these levels the most. Secondary outcomes were quality of life and adverse events. Using multivariate analysis, Dong et al demonstrated that PEG maintained the highest body weight and skeletal mass index while having the lowest rate of esophagitis and no tumor seeding.

PO intake should always be given a chance to maintain adequate nutrition to promote normal digestive physiology, and preemptive PEG placement for all patients with ESCC would inherently increase procedural complications and healthcare cost. However, when considering the applicability of this study, endoscopists should also consider available future options. PEG would allow for nutrition access if PO intake during/after therapy is inadequate and potential access to endoscopic rendezvous stent placement through the PEG site should post-radiation esophagitis result in stricture formation.1 These strictures can form months after radiotherapy, and thus it is reasonable to discuss the role of continued PEG access despite increased PO tolerance or decreased dysphagia during/after ESCC treatment.2 Nasogastric tubes allow for bedside access of nutrition; however, these are never a long-term solution given cutaneous injury risk and limitations with disposition to skilled nursing facilities.

References

Baumgart DC, Veltzke-Schlieker W, Wiedenmann B, et al. Successful recanalization of a completely obliterated esophageal stricture by using an endoscopic rendezvous maneuver. Gastrointestinal Endoscopy. 2005; 61(3) 473-475. https://www.giejournal.org/article/S0016-5107(04)02789-0/fulltext
Lawson JD, Otto K, Grist W, et al. Frequency of esophageal stenosis after simultaneous modulated accelerated radiation therapy and chemo therapy for head and neck cancer. Am J Otolaryngol. 2008;29(1):13–19. https://www.sciencedirect.com/science/article/abs/pii/S0196070906003103

Thank you for these posts.

I had 4 feeding tube surgeries ( 2 j and 2 g)the g tube in my stomach has never been a real issue and isa blessing. I do Jevity formulas and other high protein, high calories and low sugar liquids. I still spit up and vomit but am maintaining a 125 pounds plus and have energy enough to do things a few days a week

My j tube surgery was supposed to be an afternoon affair which turned into 4 surgeries in a little over a week, the j became a g tube and permanent. These caregivers and surgeons don't care about doing right anymore.