Medicinal, Psychological, and Health Research Journal (MPHRJ)

Post Esophageal Surgery Dysphagia and Nutritional Support in the Intensive Care Unit

Document Type : Review

Authors

Hosein Shiri 1
Nima Ashrafi 2

1 Assistant Professor of Surgery, Department of Cardiovascular Surgery, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 ICU fellowship candidate , Department of anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

10.22034/mphrj.2026.586240.1094
Abstract
Dysphagia is a frequent and clinically significant complication following esophageal surgery, particularly esophagectomy, and it poses substantial challenges in the postoperative management of critically ill patients. Impaired swallowing after surgery may arise from multiple mechanisms, including anatomical alterations, neural injury, postoperative inflammation, motility disorders, and anastomotic strictures. These factors can disrupt the coordinated physiological process of swallowing and increase the risk of serious complications. In the intensive care unit (ICU), early identification and appropriate management of dysphagia are essential to prevent adverse outcomes such as aspiration pneumonia, malnutrition, dehydration, and prolonged hospitalization. Comprehensive evaluation strategies—including bedside clinical assessment, standardized screening tests, and instrumental diagnostic methods such as videofluoroscopic swallow study and fiberoptic endoscopic evaluation of swallowing—play a crucial role in detecting swallowing dysfunction and guiding clinical decisions. Nutritional management is another key component of postoperative care, as patients with dysphagia often experience inadequate oral intake during the early recovery phase. Early initiation of nutritional support, preferably through enteral routes, helps maintain metabolic stability and supports tissue healing. Multidisciplinary collaboration among intensivists, surgeons, dietitians, and speech language pathologists is fundamental for optimizing patient outcomes. Rehabilitation strategies, including swallowing therapy, postural adjustments, and targeted muscle exercises, can facilitate functional recovery and reduce aspiration risk. In addition, structured ICU protocols and enhanced recovery pathways may contribute to improved postoperative outcomes by promoting safe nutritional progression and coordinated care.

Graphical Abstract

Post Esophageal Surgery Dysphagia and Nutritional Support in the Intensive Care Unit

Keywords

postoperative dysphagia
esophagectomy
nutritional support
intensive care unit
Subjects
[1]    Adler, D. G., Fang, J., Wong, R., Wills, J., & Hilden, K. (2009). Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy. Gastrointestinal Endoscopy, *70*(4), 614–619.
[2]    Altemur Karamustafaoglu, Y., & Yoruk, Y. (2010). Self-expandable esophageal stents placement for the palliation of dysphagia as a result of lung cancer. Diseases of the Esophagus, *23*(7), 561–564.
[3]    Bower, M., Jones, W., Vessels, B., Scoggins, C., & Martin, R. (2009). Nutritional support with endoluminal stenting during neoadjuvant therapy for esophageal malignancy. Annals of Surgical Oncology, *16*(11), 3161–3168.
[4]    Brown, R. E., Abbas, A. E., Ellis, S., Williams, S., Scoggins, C. R., McMasters, K. M., & Martin, R. C. G. (2011). A prospective phase II evaluation of esophageal stenting for neoadjuvant therapy for esophageal cancer: Optimal performance and surgical safety. Journal of the American College of Surgeons, *212*(4), 582–588.
[5]    Camidge, D. R. (2001). The causes of dysphagia in carcinoma of the lung. Journal of the Royal Society of Medicine, *94*(11), 567–572.
[6]    Canaud, L., Alric, P., Gandet, T., Marty-Ané, C., & Becquemin, J. P. (2013). Management of secondary aorto-esophageal fistula after thoracic endograft implantation. European Journal of Vascular and Endovascular Surgery, *45*(3), 282–288.
[7]    Canaud, L., Ozdemir, B. A., Beecher, S., Hinchliffe, R. J., & Loftus, I. M. (2014). Thoracic endovascular aortic repair for aorto-esophageal fistula: A review of the literature. Journal of Vascular Surgery, *59*(1), 248–254.
[8]    Chen, Y. H., Li, S. H., Chiu, Y. C., et al. (2012). Comparative study of esophageal stent and feeding gastrostomy/jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma. PLoS One, *7*(8), e42766.
[9]    Christie, N. A., Buenaventura, P. O., Fernando, H. C., et al. (2001). Results of expandable metal stents for malignant esophageal obstruction in 100 patients: Short-term and long-term follow-up. The Annals of Thoracic Surgery, *71*(6), 1797–1801.
[10] Dai, Y., Sascha, S., Chopra, S., Kneif, S., & Hünerbein, M. (2011). Management of esophageal anastomotic leaks, perforations, and fistulae with self-expanding plastic stents. The Journal of Thoracic and Cardiovascular Surgery, *141*(5), 1213–1217.
[11] Duron, V., Fadeku, A., & White, R. (2011). Stent placement in esophageal cancer as a bridge to surgery: Short-term outcomes. Chest, *140*(4 Suppl), 830A.
[12]             Mohammadi,K . (2026). CHA₂DS₂ VASc, anticoagulation, echocardiographic, thrombosis. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(1), 17-25.
[13] Fitzmaurice, C., Allen, C., Barber, R. M., et al. (2017). Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A systematic analysis for the Global Burden of Disease Study. JAMA Oncology, *3*(4), 524–548.
[14] Fonseca, J., Santos, C. A., & Brito, J. (2016). Malnutrition and clinical outcome of 234 head and neck cancer patients who underwent percutaneous endoscopic gastrostomy. Nutrition and Cancer, *68*(4), 589–597.
[15] Grilo, A., Santos, C. A., & Fonseca, J. (2012). Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting. Arquivos de Gastroenterologia, *49*(3), 227–231.
[16] Hirdes, M. M., Vleggaar, F. P., de Beule, M., & Siersema, P. D. (2013). In vitro evaluation of the radial and axial force of self-expanding esophageal stents. Endoscopy, *45*(12), 997–1005.
[17] Homs, M. Y., Steyerberg, E. W., Kuipers, E. J., et al. (2004). Causes and treatment of recurrent dysphagia after self-expanding metal stent placement for palliation of esophageal carcinoma. Endoscopy, *36*(10), 880–886.
[18] Jones, C. M., & Griffiths, E. A. (2014). Should esophageal stents be used before neo-adjuvant therapy to treat dysphagia in patients awaiting oesophagectomy? Best evidence topic (BET). International Journal of Surgery, *12*(11), 1172–1180.
[19] Khan, F. R., Hashim, A., & Rathore, M. A. (2019). Delayed esophageal fistula following TEVAR: A case report and review of literature. Annals of Vascular Surgery, *60*, 443.e1–443.e5.
[20] Kjaer, D. W., Nassar, M., Jensen, L. S., Svendsen, L. B., & Mortensen, F. V. (2017). A bridging stent to surgery in patients with esophageal and gastroesophageal junction cancer has a dramatic negative impact on patient survival: A retrospective cohort study through data acquired from a prospectively maintained national database. Diseases of the Esophagus, *30*(3), 1–7.
[21] Krokidis, M., Burke, C., Spiliopoulos, S., Gkoutzios, P., Hynes, O., Ahmed, I., & Zampakis, P. (2013). The use of biodegradable stents in malignant esophageal strictures for the treatment of dysphagia before neoadjuvant treatment or radical radiotherapy: A feasibility study. CardioVascular and Interventional Radiology, *36*(4), 1047–1054.
[22] Langer, F. B., Schoppmann, S. F., Prager, G., Tomaselli, F., Pluschnig, U., Hejna, M., ... & Zacherl, J. (2010). Temporary placement of self-expanding esophageal stents as bridging for neo-adjuvant therapy. Annals of Surgical Oncology, *17*(2), 470–475.
[23] Löser, C., Aschl, G., Hébuterne, X., et al. (2005). ESPEN guidelines on artificial enteral nutrition–percutaneous endoscopic gastrostomy (PEG). Clinical Nutrition, *24*(5), 848–861.
[24] Löser, C., Wolters, S., & Fölsch, U. R. (1998). Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients: A four-year prospective study. Digestive Diseases and Sciences, *43*(11), 2549–2557.
[25] Maguire, P. D., Sibley, G. S., Zhou, S. M., et al. (1999). Clinical and dosimetric predictors of radiation-induced esophageal toxicity. International Journal of Radiation Oncology, Biology, Physics, *45*(1), 97–103.
[26] Mao-de-Ferro, S., Serrano, M., Ferreira, S., et al. (2016). Stents in patients with esophageal cancer before chemoradiotherapy: High risk of complications and no impact on the nutritional status. European Journal of Clinical Nutrition, *70*(3), 409–410.
[27] Mariette, C., De Botton, M. L., & Piessen, G. (2012). Surgery in esophageal and gastric cancer patients: What is the role for nutrition support in your daily practice? Annals of Surgical Oncology, *19*(7), 2128–2134.
[28] Mariette, C., Gronnier, C., Duhamel, A., Mabrut, J.-Y., Bail, J.-P., Carrere, N., ... & Piessen, G. (2015). Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer: Impact on oncologic outcomes. Journal of the American College of Surgeons, *220*(3), 287–296.
[29] Martin, R., Duvall, R., Ellis, S., & Scoggins, C. R. (2009). The use of self-expanding silicone stents in esophageal cancer care: Optimal pre-, peri-, and postoperative care. Surgical Endoscopy, *23*(3), 615–621.
[30] Mills, A., Tanaka, A., Dawson, A., Hetz, R., Smith, H., Lopez, M., Safi, H., & Estrera, A. (2024). Management of aortoesophageal fistula primarily using esophageal preservation. JTCVS Open, *16*, 31–38.
[31] Min, Y. W., Jang, E. Y., Jung, J. H., et al. (2017). Comparison between gastrostomy feeding and self-expandable metal stent insertion for patients with esophageal cancer and dysphagia. PLoS One, *12*(6), e0179522.
[32] Mozaffarian, D., Benjamin, E. J., Go, A. S., et al. (2016). Executive summary: Heart disease and stroke statistics—2016 update: A report from the American Heart Association. Circulation, *133*(4), 447–454.
[33] Nagaraja, V., Cox, M. R., & Eslick, G. D. (2014). Safety and efficacy of esophageal stents preceding or during neoadjuvant chemotherapy for esophageal cancer: A systematic review and meta-analysis. Journal of Gastrointestinal Oncology, *5*(2), 119–126.
[34] Park, J. H., Song, H. Y., Shin, J. H., Kim, J. H., Kim, Y. H., Kim, S. B., & Kim, J. H. (2015). Preliminary results of temporary placement of retrievable expandable metallic stents during preoperative neoadjuvant chemoradiotherapy in patients with resectable esophageal cancer. Journal of Vascular and Interventional Radiology, *26*(6), 883–888.
[35] Pellen, M. G. C., Sabri, S., Razack, A., Gilani, S. Q., & Jain, P. K. (2012). Safety and efficacy of self-expanding removable metal esophageal stents during neoadjuvant chemotherapy for resectable esophageal cancer. Diseases of the Esophagus, *25*(1), 48–53.
[36] Roy, A., Kim, M., Christein, J., & Varadarajulu, S. (2012). Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: Comparison of clinical outcomes and costs. Surgical Endoscopy, *26*(11), 3114–3119.
[37] Rubicondo, C., Lovece, A., Pinelli, D., Indriolo, A., Lucianetti, A., & Colledan, M. (2020). Endoluminal vacuum-assisted closure (E-Vac) therapy for postoperative esophageal fistula: Successful case series and literature review. World Journal of Surgical Oncology, *18*, 301.
[38] Sabbagh, C., Browet, F., Diouf, M., Cosse, C., Brehant, O., Bartoli, E., ... & Regimbeau, J. M. (2013). Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Annals of Surgery, *258*(1), 107–115.
[39]             Milanifard,M and Hashemloo,A . (2025). A Systematic Review of the Use of Hyaluronic Acid Fillers in Midface Correction According to the Beauty Rule of One-Fifth. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(1), 10-16.
[40] Saito, H., Yamamoto, H., Okamoto, K., Yoshida, S., & Matsumoto, T. (2020). Endovascular repair of aorto-esophageal fistula after thoracic aortic stent grafting: Case report and literature review. Annals of Vascular Surgery, *64*, 318.e1–318.e5.
[41] Schoel, L. J., & Lagisetty, K. (2024). Aorto-esophageal fistula management. Thoracic Surgery Clinics, *34*(4), 385–394.
[42] Segura, A., Pardo, J., Jara, C., et al. (2005). An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer. Clinical Nutrition, *24*(5), 801–814.
[43] Siddiqui, A. A., Glynn, C., Loren, D., & Kowalski, T. (2009). Self-expanding plastic esophageal stents versus jejunostomy tubes for the maintenance of nutrition during neoadjuvant chemoradiation therapy in patients with esophageal cancer: A retrospective study. Diseases of the Esophagus, *22*(3), 216–222.
[44] Siddiqui, A. A., Loren, D., Dudnick, R., & Kowalski, T. (2007). Expandable polyester silicon-covered stent for malignant esophageal strictures before neoadjuvant chemoradiation: A pilot study. Digestive Diseases and Sciences, *52*(3), 823–829.
[45] Siddiqui, A. A., Sarkar, A., Beltz, S., Lewis, J., Loren, D., & Kowalski, T. (2012). Placement of fully covered self-expandable metal stents in patients with locally advanced esophageal cancer before neoadjuvant therapy. Gastrointestinal Endoscopy, *76*(1), 44–51.
[46] Sofue, K., Takeuchi, Y., Tsurusaki, M., et al. (2016). Value of percutaneous radiologic gastrostomy for patients with advanced esophageal cancer. Annals of Surgical Oncology, *23*(11), 3623–3631.
[47] Spaander, M. C., Baron, T. H., Siersema, P. D., Fuccio, L., Schumacher, B., Escorsell, À., ... & van Hooft, J. E. (2016). Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy, *48*(10), 939–948.
[48] Stankey, R. M., Roshe, J., & Sogocio, R. M. (1969). Carcinoma of the lung and dysphagia. Diseases of the Chest, *55*(1), 13–17.
[49] Sunde, B., Ericson, J., Kumagai, K., Lundell, L., Tsai, J. A., Lindblad, M., ... & Rouvelas, I. (2015). Relief of dysphagia during neoadjuvant treatment for cancer of the esophagus or gastroesophageal junction. Diseases of the Esophagus, *29*(5), 442–447.
[50]             Hashemloo,A and Milanifard,M . (2025). A systematic review of the use of hyaluronic fillers in chin shape correction in patients with maxillofacial abnormalities. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(1), 1-9.
[51] Tao, M., Shlomovitz, E., Darling, G., & Roche-Nagle, G. (2016). Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting. World Journal of Clinical Cases, *4*(8), 233–237.
[52] Tessier, W., Piessen, G., Briez, N., Boschetto, A., Sergent, G., & Mariette, C. (2013). Percutaneous radiological gastrostomy in esophageal cancer patients: A feasible and safe access for nutritional support during multimodal therapy. Surgical Endoscopy, *27*(2), 633–641.
[53] van den Berg, M. W., Walter, D., de Vries, E. M., Vleggaar, F. P., van Berge Henegouwen, M. I., van Hillegersberg, R., ... & Siersema, P. D. (2014). Biodegradable stent placement before neoadjuvant chemoradiotherapy as a bridge to surgery in patients with locally advanced esophageal cancer. Gastrointestinal Endoscopy, *80*(5), 908–913.
[54] Vleggaar, F. P. (2009). Stent placement in esophageal cancer as a bridge to surgery. Gastrointestinal Endoscopy, *70*(4), 620–622.
[55] Wedemeyer, J., Brangewitz, M., Kubicka, S., & Manns, M. P. (2008). Endoscopic vacuum-assisted closure of upper gastrointestinal leaks. Gastrointestinal Endoscopy, *68*(4), 705–709.
Medicinal, Psychological, and Health Research Journal (MPHRJ)
Volume 2, Issue 5
September and October 2026
Pages 339-350

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