Prospective evaluation of malignant cell seeding after percutaneous endoscopic gastrostomy in patients with oropharyngeal/esophageal cancers

Abstract

This study showed that malignant cells were present in 22.5 % of patients immediately after pull-through PEG placement; local metastases were verified at follow-up in 9.4 %, all of which were from esophageal squamous cell carcinoma. This risk is particularly high in the older age group and in patients with higher tumor stages. Therefore, pull-through PEG placement should be avoided in these patients and direct access PEG favored instead.

The Tibal Nerve (Posterior Tibal Nerve): Anatomical Course and Relation at the Ankle

“…the latest literature review in 2013 showed stomal metastases after percutaneous endoscopic gastrostomy (PEG) in 42 patients being the oropharynx the most common site with (40%), hypopharynx (29%) oral cavity (17%), and larynx (14%), the method of PEG tube insertion was documented in 29 cases, with 28 (96.6%) reporting use of the ("pull") technique [13,36,37]. Recently Ellrichmann et al [37] Open Acc Res Anatomy study of 50 cases of oropharyngeal and esophageal malignancies that showed malignant tumor cells present on 22.5% from PEG tube or brush cytology of the incision site immediately after PEG placement with pull technique [36,38].…”

Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?

“…This type of metastasis was first described in 1977 in the skin and 1989 in the abdominal wall [27,28] . In a prospective trial with 50 patients suffering from oropharyngeal or esophageal cancer, Ellrichmann et al [29] demonstrated tumor seeding to the PEG insertion site in cytology in 9.4% of cases. The rate was especially high in older patients with advanced stages of esophageal tumor.…”

Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer

“…Minor complications resulting from PEG tube placement include cellulitis, ileus, peristomal leakage, extrusion, tube obstruction and gastric wall hematoma formation. Major complications include peritonitis, hemorrhage, airway aspiration, peristomal wound infection, buried bumper syndrome, tumor implantation and gastrocolic fistula [28,29] (Table 1). The major complications of the standard pull/push method, which requires an esophageal lumen sufficient to pass a standard endoscope [30] , include peristomal wound infections, presumably resulting from contamination of the gastrostomy catheter as it passes through the oral cavity [14,31] , and tumor implantation at the PEG site [28,32] which are specific for pull/push method in the aerodigestive cancer patients.…”

“…Major complications include peritonitis, hemorrhage, airway aspiration, peristomal wound infection, buried bumper syndrome, tumor implantation and gastrocolic fistula [28,29] (Table 1). The major complications of the standard pull/push method, which requires an esophageal lumen sufficient to pass a standard endoscope [30] , include peristomal wound infections, presumably resulting from contamination of the gastrostomy catheter as it passes through the oral cavity [14,31] , and tumor implantation at the PEG site [28,32] which are specific for pull/push method in the aerodigestive cancer patients. In the literature on patients with cancer, the overall complication and mortality rates of the pull/push method in patients with head and neck cancer are 10.9%-42.0% and 0%-5%, respectively [15,17,18,[20][21][22][33][34][35][36] .…”