Abstract
The implantation of metastasis of oropharyngeal or esophageal cancer to percutaneous endoscopic gastrostomy (PEG) stomata is considered an uncommon complication, but it is being recognized with increasing frequency. The incidence of this complication is not known. Multiple theories of metastatic spread have been proposed. We describe a case following retrograde endoscopy via a PEG stoma site. A National Library of Medicine literature search was performed, and case reports and bibliographies were reviewed. We estimate the incidence of this complication as 1% minimum. Direct seeding of the site is the only reasonable hypothesis to explain this phenomenon. Health care providers need to be educated about this problem. Although there is no direct evidence that metastases are spread by direct contact, we believe that transgression of the active primary tumor during gastrostomy tube placement should be avoided. Laparoscopic gastrostomy tube placement provides a safe, effective, and minimally invasive method of enteral access, which avoids transgression of the primary tumor site, and may prevent stomal metastases in patients with active aerodigestive tract malignancies who require gastrostomy.
Similar content being viewed by others
References
TT Alagaratnam (1977) ArticleTitleWound implantation—a surgical hazard. Br J Surg 64 872–875 Occurrence Handle1:STN:280:CSeD287lvVI%3D Occurrence Handle338091
G Becker CF Hess KE Grund W Hoffmann M Bamberg (1995) ArticleTitleAbdominal wall metastasis following percutaneous endoscopic gastrostomy. Support Care Cancer 3 313–316
MC Brown (2000) ArticleTitleCancer metastasis at percutaneous endoscopic gastrostomy stomata is related to the hematogenous or lymphatic spread of circulating tumor cells. Am J Gastroenterol 95 3288–3291 Occurrence Handle10.1016/S0002-9270(00)02132-8 Occurrence Handle1:STN:280:DC%2BD3M%2FnsFKgsw%3D%3D Occurrence Handle11095357
L Bushnell TW White JG Hunter (1991) ArticleTitleMetastatic implantation of laryngeal carcinoma at a PEG exit site. Gastrointest Endosc 37 480–482
I Claros Gonzalez JL Santonja Garriga S Rubio Barbon L Santamaria Giron A Trivino Lopez A Velasco Alvarez (1994) ArticleTitleJejunal perforation as initial metastatic manifestation of laryngeal carcinoma. Rev Esp Enferm Dig 85 41–44 Occurrence Handle1:STN:280:ByuB2c3ltVU%3D Occurrence Handle8186002
G Clayman JI Cohen GL Adams (1993) ArticleTitleNeoplastic seeding of squamous cell carcinoma of the oropharynx. Head Neck 15 245–248 Occurrence Handle1:STN:280:ByyB2MbnvVI%3D Occurrence Handle8491588
DR Cunliffe C Swanton C White SR Watt-Smith TA Cook BD George (2000) ArticleTitlePercutaneous endoscopic gastrostomy at the time of tumour resection in advanced oral cancer. Oral Oncol 36 471–473 Occurrence Handle10.1016/S1368-8375(00)00038-5 Occurrence Handle10964056
M Deinzer M Menges K Walter W Puschel A Braun et al. (1999) ArticleTitleImplantation metastasis at the exit site after percutaneous endoscopic gastrostomy in esophageal carcinoma. Z Gastroenterol 37 789–937 Occurrence Handle1:STN:280:DyaK1MvltFylsQ%3D%3D Occurrence Handle10522365
EE Deurloo LJ Schultze Kool R Kroger F van Coevorden AJ Balm (2001) ArticleTitlePercutaneous radiological gastrostomy in patients with head and neck cancer. Eur J Surg Oncol 27 94–97 Occurrence Handle10.1053/ejso.2000.1026 Occurrence Handle1:STN:280:DC%2BD3M7osFWktw%3D%3D Occurrence Handle11237498
JG Douglas W Koh GE Laramore (2000) ArticleTitleMetastasis to a percutaneous gastrostomy site from head and neck cancer: radiobiologic considerations. Head Neck 22 826–830 Occurrence Handle10.1002/1097-0347(200012)22:8<826::AID-HED13>3.0.CO;2-P Occurrence Handle1:STN:280:DC%2BD3M%2Fot1KgsA%3D%3D Occurrence Handle11084645
QY Duh LW Way (1993) ArticleTitleLaparoscopic gastrostomy using T-fasteners as retractors and anchors. Surg Endosc 7 60–63
JJ Fagan JW Loock (1996) ArticleTitleTracheostomy and peristomal recurrence. Clin Otolaryngol 21 328–303 Occurrence Handle1:STN:280:ByiD2cvit1w%3D Occurrence Handle8889299
PJ Gaurderer MWL RJ Izant (1980) ArticleTitleGastrostomy without laparotomy; a percutaneous endoscopic technique. J Pediatr Surg 15 872–875 Occurrence Handle1:STN:280:Bi6C3Mbks1Y%3D Occurrence Handle6780678
K Georgeson E Owings (1998) ArticleTitleSurgical and laparoscopic techniques for feeding tube placement. Gastrointest Endosc Clin North Am 8 581–592
S Gibson (1992) ArticleTitlePercutaneous endoscopic gastrostomy in the management of head and neck carcinoma. Laryngoscope 102 977–980 Occurrence Handle1:STN:280:By2A1cbntF0%3D Occurrence Handle1518361
W Halfpenny M McGurk (2001) ArticleTitleStomal recurrence following temporary tracheostomy. J Laryngol Otol 115 202–204 Occurrence Handle10.1258/0022215011907190 Occurrence Handle1:STN:280:DC%2BD3MzgsFektQ%3D%3D Occurrence Handle11244526
N Heinbokel V Konig A Nowak V Carstens (1993) ArticleTitleA rare complication of percutaneous endoscopic gastrostomy: metastasis of adenocarcinoma of the stomach in the area of the gastric stoma. Z Gastroenterol 31 612–613 Occurrence Handle1:STN:280:ByuD2sfmt1Q%3D Occurrence Handle7504855
M Hosseini JG Lee (1999) ArticleTitleMetastatic esophageal cancer leading to gastric perforation after repeat PEG placement. Am J Gastroenterol 94 2556–2558 Occurrence Handle10.1016/S0002-9270(99)00451-7 Occurrence Handle1:STN:280:DyaK1MvhtFyhtQ%3D%3D Occurrence Handle10484026
DE TG Huang WR Wilson (1992) ArticleTitleStomal seeding by percutaneous endoscopic gastrostomy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 118 658–659 Occurrence Handle1:STN:280:By2A2cvot1M%3D Occurrence Handle1637545
A WS Hussain J Massey A Geddes J Cox (1996) ArticleTitlePercutaneous endoscopic gastrostomy. Postgrad Med J 72 581–585 Occurrence Handle1:STN:280:ByiC3s3kvVY%3D Occurrence Handle8977937
S Koscielny B Brauer J Koch G Kahler (2001) ArticleTitleAbdominal wall metastases as a complication of percutaneous endoscopic gastrostomy in carcinoma of the upper aerodigestive tract. Hno 49 392–395 Occurrence Handle10.1007/s001060050769 Occurrence Handle1:STN:280:DC%2BD3Mzkt1eltQ%3D%3D Occurrence Handle11405149
O Laccourreye E Chabardes A Merite-Drancy F Carnot P Renard et al. (1993) ArticleTitleImplantation metastasis following percutaneous endoscopic gastrostomy. J Laryngol Otol 107 946–999 Occurrence Handle1:STN:280:ByuD1cjgsFw%3D Occurrence Handle8263399
R Lauvin R Hignard D Picot R Hellegouarc’h (1996) ArticleTitleTumor graft on the tract of the catheter of percutaneous gastrostomy inserted by endoscopic approach in a patient treated for inoperable cancer of the esophagus. Presse Med 25 556 Occurrence Handle1:STN:280:BymA3cnkslQ%3D
DS Lee MA Mohit-Tabatabai BF Rush Jr C Levine (1995) ArticleTitleStomal seeding of head and neck cancer by percutaneous endoscopic gastrostomy tube placement. Ann Surg Oncol 2 170–173 Occurrence Handle1:STN:280:ByqB2crotV0%3D Occurrence Handle7728572
HS Lin HZ Ibrahim JW Kheng WE Fee DJ Terris (2001) ArticleTitlePercutaneous endoscopic gastrostomy: strategies for prevention and management of complications. Laryngoscope 111 1847–1852 Occurrence Handle1:STN:280:DC%2BD38%2FntlentQ%3D%3D Occurrence Handle11801956
DP Lookingbill N Spangler KF Helm (1993) ArticleTitleCutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol 29 228–236 Occurrence Handle1:STN:280:ByyA38fosFU%3D Occurrence Handle8335743
H GU Massoun BC Manegold (1993) ArticleTitlePuncture metastasis after percutaneous endoscopic gastrostomy. Chirurg 64 71–72 Occurrence Handle1:STN:280:ByyC2s%2Fgs1Q%3D Occurrence Handle8436055
TM Mekhail DJ Adelstein LA Rybicki MA Larto JP Saxton P Lavertu (2001) ArticleTitleEnteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 91 1785–1790 Occurrence Handle10.1002/1097-0142(20010501)91:9<1785::AID-CNCR1197>3.3.CO;2-T Occurrence Handle1:STN:280:DC%2BD3M3jvFOqtw%3D%3D Occurrence Handle11335904
MF KD Meurer (1993) ArticleTitleMetastatic head and neck carcinoma in a percutaneous gastrostomy site: Head Neck 15 70–73 Occurrence Handle1:STN:280:ByyC3cnnvFc%3D Occurrence Handle8416862
KM Murayama TJ Johnson JS Thompson (1996) ArticleTitleLaparoscopic gastrostomy and jejunostomy are safe and effective for obtaining enteral access. Am J Surg 172 591–595 Occurrence Handle10.1016/S0002-9610(96)00246-2 Occurrence Handle1:STN:280:ByiD1Mfgt1w%3D Occurrence Handle8942569
PL Peghini N Guaouguaou JA Salcedo FH Al-Kawas (2000) ArticleTitleImplantation metastasis after PEG: case report and review. Gastrointest Endosc 51 480–482 Occurrence Handle1:STN:280:DC%2BD3c3gvFahtA%3D%3D Occurrence Handle10744826
JL Ponsky (1981) ArticleTitlePercutaneous endoscopic gastrostomy; a nonoperative technique for feeding gastrostomy. Gastrointest Endosc 27 9–11
S Preyer (1989) ArticleTitleGastric metastasis of squamos cell carcinoma of the head and neck after percutaneous endoscopic gastrostomy—report of a case. Endoscopy 21 295 Occurrence Handle1:STN:280:By%2BC38nmslM%3D Occurrence Handle2612434
L Riera A Sandiumenge C Calvo JM Bordas I Alobid et al. (2002) ArticleTitlePercutaneous endoscopic gastrostomy in head and neck cancer patients. J Otorhinolaryngol Relat Spec 64 32–34 Occurrence Handle10.1159/000049265 Occurrence Handle1:STN:280:DC%2BD387lvVaqsg%3D%3D
E Ringstrom TW Matthews HB Lampe C Currie (1999) ArticleTitleRole of percutaneous gastrostomy tubes in the postoperative care of patients with cancer of the oral cavity and oropharynx. J Otolaryngol 28 68–72 Occurrence Handle1:STN:280:DyaK1M3ivFensw%3D%3D Occurrence Handle10212871
TR Russel Norris BM, (1984) ArticleTitlePercutaneous gastrostomy: a new simplified and cost effective technique. Am J Surg 148 132–137 Occurrence Handle6430111
GD Schapiro SA Edmundowicz (1996) ArticleTitleComplications of percutaneous endoscopic gastrostomy. Gastrointest Endosc Clin North Am 6 409–422 Occurrence Handle1:STN:280:BymB2M3hvVA%3D
TD PD Schiano L Harrison (1994) ArticleTitleNeoplastic seeding as a complication of percutaneous endoscopic gastrostomy [Letter]. Am J Gastroenterol 89 131–133 Occurrence Handle1:STN:280:ByuD1MbjsVA%3D Occurrence Handle8273785
AM Schneider BW Loggie (1997) ArticleTitleMetastatic head and neck cancer to the percutaneous endoscopic gastrostomy exit site: a case report and review of the literature. Am Surg 63 481–486 Occurrence Handle1:STN:280:ByiA3M3jtFI%3D Occurrence Handle9168757
CA Schurink H Tuynman P Scholten W Arjaans EC Klinkenberg-Knol et al. (2001) ArticleTitlePercutaneous endoscopic gastrostomy: complications and suggestions to avoid them. Eur J Gastroenterol Hepatol 13 819–823 Occurrence Handle10.1097/00042737-200107000-00010 Occurrence Handle1:STN:280:DC%2BD3Mvislaruw%3D%3D Occurrence Handle11474312
P Sharma SM Berry K Wilson H Neale AS Fink (1994) ArticleTitleMetastatic implantation of an oral squamous-cell carcinoma at a percutaneous endoscopic gastrostomy site. Surg Endosc 8 1232–1235 Occurrence Handle1:STN:280:ByqC3cfns1A%3D Occurrence Handle7809814
JJ Sinclair JS Scolapio ME Stark RA Hinder (2001) ArticleTitleMetastasis of head and neck carcinoma to the site of percutaneous endoscopic gastrostomy: case report and literature review. J Parenteral Enteral Nutr 25 282–285 Occurrence Handle1:STN:280:DC%2BD3MvovVCqug%3D%3D
WE Strodel DE Kenady (1995) ArticleTitleStomal seeding of head and neck cancer by percutaneous endoscopic gastrostomy (PEG) tube. Ann Surg Oncol 2 462–463 Occurrence Handle1:STN:280:BymD2cnpvVE%3D Occurrence Handle7496844
WE Strodel DE Kenady TN Zweng (1995) ArticleTitleAvoiding stoma seeding in head and neck cancer patients. Surg Endosc 9 1142–1143 Occurrence Handle1:STN:280:BymC3MfhtFc%3D Occurrence Handle8553223
D Thorburn KS Soutar (1997) ArticleTitleTumour seeding following percutaneous endoscopic gastrostomy placement in head and neck cancer. Postgrad Med J 73 430–432 Occurrence Handle1:STN:280:ByiH2sbjvVU%3D Occurrence Handle9338033
KJ van Erpecum WL Akkersdijk CC Warlam-Rodenhuis GP van Berge Henegouwen TJ van Vroonhoven (1995) ArticleTitleMetastasis of hypopharyngeal carcinoma into the gastrostomy tract after placement of a percutaneous endoscopic gastrostomy catheter. Endoscopy 27 124–127 Occurrence Handle1:STN:280:ByqA38vksVE%3D Occurrence Handle7601024
F Waldfahrer H Iro (2002) ArticleTitleBasic principles and concepts of enteral nutrition of ENT patients. Hno 50 201–208 Occurrence Handle10.1007/s00106-001-0613-5
GM Walton (1999) ArticleTitleComplications of percutaneous gastrostomy in patients with head and neck cancer—an analysis of 42 consecutive patients. Ann R Coll Surg Engl 81 272–276 Occurrence Handle1:STN:280:DC%2BD3c%2Fot1Slsg%3D%3D Occurrence Handle10615198
RA Weisman M Colman PH Ward (1979) ArticleTitleStomal recurrence following laryngectomy: a critical evaluation. Ann Otol Rhinol Laryngol 88 855–860 Occurrence Handle1:STN:280:Bi%2BD1cnisFQ%3D Occurrence Handle517931
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maccabee, D., Sheppard, B. Prevention of percutaneous endoscopic gastrostomy stoma metastases in patients with active oropharyngeal malignancy . Surg Endosc 17, 1678 (2003). https://doi.org/10.1007/s00464-002-4553-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-002-4553-2