Abdominal wall metastasis following percutaneous endoscopic gastrostomy

Abstract

Percutaneous endoscopic gastrostomy (PEG) has become a widely used method for nutritional support, particularly in patients with advanced head and neck carcinomas. Since the method is easy and widely established it is necessary to assess possible complications, even rare ones. In this paper we report on two patients with vaccination metastasis following PEG insertion. Both patients had advanced squamous cell carcinoma of the head and neck or the upper esophagus. In three patients previous bougienage was performed, because of considerable stenosis of the pharynx and/or esophagus. Fast-growing metastases were found at the site of PEG insertion, with and without involvement of the gastric wall. In neither case was abdominal wall metastasis the cause of death. There is a small but definite risk of tumor seeding into the abdominal wall after PEG insertion for obstructive malignant tumors. The clinical impact of this finding, however, is still undefined and needs further investigation.

Risk Factors and Risk Reduction of Malignant Seeding of the Percutaneous Endoscopic Gastrostomy Track from Pharyngoesophageal Malignancy: A Review of all 44 Known Reported Cases

“…This time lag presumably reflects the time required for exfoliated and implanted cancerous cell(s) to multiply to become grossly evident. In five (11%) cases, stomal metastases were diagnosed after PEG removal (mean 5.8 ± 4.0 months thereafter, range 2-10 months (7,14,17,26,32)). The clinical presentation of stomal metastases on the abdominal wall or the gastric wall is described in Table 1A and B, respectively.…”

Abdominal Wall Vaccination Metastasis Following Percutaneous Endoscopic Gastrostomy

“…As in other patients reported in the literature, the metastasis occurred 3-5 months after PEG insertion. All other patients died from pulmonary metastasis or deterioration of the general condition, 1-5 months after the diagnosis of abdominal wall metastasis [9][10][11]. In contrast our patient is still alive 9 months after the first sign of a wall metastasis.…”

“…Major complications are rare and described in small studies [3]. They include typical surgical complications such as necrotizing fasciitis [4], fistula [5], gastric defect [6], airways obstruction with respiration arrest [7], pneumonia following aspiration [8], and 4 cases of abdominal wall metastasis [9][10][11]. The incidence of severe side effects is estimated to be about 3-7% and mortality rates are 1% [6] to 2% [12].…”

“…This complication is rare and its occurrence does not alter the indication for a PEG. Pradier/Weiss/Eberlein/Hess [10] after PEG carcinoma, poorly diagnosis (lung metastasis) differentiated Becker sinus piriformis T4N3M0 3 months fusicellular squamous resection death 2 months after the et al [9] after PEG cell carcinoma, poorly diagnosis (lung metastasis) differentiated Becker esophageal carcinoma T3N1M0 5 months squamous cell resection death 6 weeks after the et al [9] cervical third after PEG carcinoma, poorly diagnosis (local progress and differentiated distant metastasis) …”

Postoperative Komplikationen von transoraler Durchzugs-PEG und Direktpunktions-PEG bei Patienten mit Kopf-Hals-Tumoren

“…Einige Autoren empfahlen daher die Nutzung eines "overtube" [40]. Eine seltene, in der Literatur aber zunehmend häufiger beschriebene Nebenwirkung ist das Auftreten von Implantationsmetastasen aufgrund von iatrogener Tumorzellverschleppung [1,5,11,27,37,43,44]. Von den bislang beschriebenen Fällen, erwies sich jedoch keine als limitierender Faktor für das Überleben des Patienten.…”