Multidisciplinary therapeutic approach for maintaining long-term nutritional status for patient with advanced esophageal carcinoma confounded by dermatomyositis

We report a patient with advanced esophageal carcinoma associated with dermatomyositis who successfully maintained long-term good nutritional status by chemoradiation therapy and continuous enteral nutrition. A 64-year-old Japanese man was admitted to our hospital because of dysphagia and systemic edema. Because of debilitated status and malnutrition, intravenous corticosteroid infusion was first performed. Continuous enteral nutrition was performed through percutaneous endoscopic gastrostomy, and chemoradiation therapy was then performed. Although the endoscopic examination revealed complete regression of esophageal carcinoma, an esophagobronchial fistula was formed. The patient was periodically followed up by a multidisciplinary team for appropriate nutritional management; as a result, nutritional status was markedly improved and well maintained. A covered, selfexpandable metallic stent was placed in the esophagus to conceal the esophagobronchial fistula. This case highlights the importance of multidisciplinary therapeutic approach for maintaining good nutritional status and quality of life in patients with advanced esophageal carcinoma confounded by debilitating disorders.