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

Cappell, Mitchell S.
June 2007
American Journal of Gastroenterology;Jun2007, Vol. 102 Issue 6, p1307
Academic Journal
AIM: To comprehensively review all known reported cases of stomal metastases after percutaneous endoscopic gastrostomy (PEG) to systematically identify risk factors for this complication and to develop strategies for reducing this risk. METHODS: Reported cases were identified by computerized literature searches. Criteria for risk factors for stomal metastases included: a substantially higher relative rate of this factor in patients with stomal metastases than expected from pharyngoesophageal malignancy in general, and biologic plausibility of this phenomenon. LITERATURE REVIEW: Review of all 44 known stomal metastases revealed the following. The mean patient age was 59.0 ± 10.0 (SD) yr, and 79% of patients were male. Pathologically proven stomal metastases were located in the abdominal wall (PEG exit site) in 63%, in the gastric wall (PEG entrance site) in 7%, and in both walls in 30%. Mean survival after diagnosis was only 4.3 ± 3.8 months. Pathologic risk factors for stomal metastases included: (a) pharyngoesophageal location of primary cancer (in 100% of cases, 0% other locations); (b) squamous cell histology (in 98%, adenocarcinoma in 2%); (c) poorly or moderately differentiated histology (in 92%, well differentiated in 8%); (d) advanced pathologic stage (in 97%, early stage in 3%); and (e) large primary cancer size at diagnosis (mean diameter 4.2 ± 2.3 cm). These risk factors appeared to be quantitatively large ( e.g., 98% of cases had squamous histology vs 50% expected rate, odds ratio 40.1, OR CI 6.31–246.4, P < 0.0001). Therapeutic risk factors for stomal metastases included: (a) endoscopic PEG placement (in 98%, surgical gastrostomy in 2%); (b) pull-string PEG technique (in 98%, push-guidewire in 2%, direct-introducer in 0%); (c) primary cancer untreated or known local recurrence after treatment before PEG (in 87%); and (d) time ≥3 months after PEG insertion (in 100%, <3 months in 0%; mean interval 7.8 ± 5.2 months after PEG). Four of the currently reported risk factors are novel (pathologic factors d,e; therapeutic factors a,d). CONCLUSIONS: Strong risk factors for stomal metastases include: pharyngoesophageal primary cancer, squamous cell histology, less well-differentiated cancer, large size, and advanced cancer stage. The risk may be reduced in patients with risk factors by radiotherapy, chemotherapy, or cancer surgery before PEG; by substituting the push-guidewire for the pull-string technique for PEG; and possibly by use of a sheath with the pull-string technique.


Related Articles

  • Percutaneous Endoscopic Gastrostomy Complications in a Tertiary-Care Center. Lockett, Mark A.; Templeton, Mia L.; Byrne, T. Karl; Norcross, E. Douglas // American Surgeon;Feb2002, Vol. 68 Issue 2, p117 

    Since its introduction in 1980 the percutaneous endoscopic gastrostomy (PEG) has become the procedure of choice for establishing enteral access. However, there is still a relatively high complication rate associated with PEG placement. We reviewed the complications associated with PEG placement...

  • Percutaneous endoscopic gastrostomy feeding in the adult patient. Best, Carolyn // British Journal of Nursing;6/25/2009, Vol. 18 Issue 12, p724 

    Percutaneous endoscopic gastrostomy (PEG) is a procedure in which a feeding tube is passed through the abdominal wall directly into the stomach under endoscopic guidance, enabling nutrients, medication and fluids to be delivered directly into the stomach. PEG feeding is the most common form of...

  • ONCE IS ENOUGH. Wootton, E. Taylor; Johnson, David // American Journal of Gastroenterology;Jun1997, Vol. 92 Issue 6, p1066 

    Discusses research being done on the necessity of the second pass of gastroscope in percutaneous endoscopic gastrostomy placement. Reference to a study by S. Sartori et al, published in a 1996 issue of the "Endoscopy" journal; Technique used over the use of gastroscope in a group of patients in...

  • early feeding and delayed feeding after PEG placement do not differ for complications or death within 72 hours. Lindeboom, Robert // Evidence Based Nursing;Apr2009, Vol. 12 Issue 2, p13 

    The article focuses on randomised controlled trials which compared early feeding with delayed or next-day feeding after percutaneous endoscopic gastrostomy (PEG) placement. These studies were based on Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness and Cochrane...

  • Erratum to: Usefulness of the introducer method for percutaneous endoscopic gastrostomy using ultrathin transnasal endoscopy. Lee, Hong; Lim, Chul-Hyun; Park, Eun; Lee, Wook-Hyun; No, Jin; Jun, Byoung; Moon, Sung; Kim, Jin; Cho, Yu; Park, Jae; Lee, In; Kim, Sang; Choi, Myung-Gyu; Choi, Kyu // Surgical Endoscopy;Feb2014, Vol. 28 Issue 2, p607 

    A correction to the article "Usefulness of the introducer method for percutaneous endoscopic gastrostomy using ultrathin transnasal endoscopy," that appeared in the January 1, 2014 online issue is presented.

  • The Incidence and Clinical Significance of Pneumoperitoneum after Percutaneous Endoscopic Gastrostomy: A Review of 722 Cases. BLUM, CRAIG A.; SELANDER, CRAIG; RUDDY, JEAN MARIE; LEON, STUART // American Surgeon;Jan2009, Vol. 75 Issue 1, p39 

    Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice for establishing enteral access in patients unable to take oral feedings. Serious complications are rare; however, misplaced PEGs and PEG/Jejunums can lead to hollow viscus injuries with intra-abdominal contamination and...

  • Propofol-Based Sedation Does Not Increase Rate of Complication during Percutaneous Endoscopic Gastrostomy Procedure. Amornyotin, Somchai; Chalayonnavin, Wiyada; Kongphlay, Siriporn // Gastroenterology Research & Practice;2011, Vol. 2011, p1 

    To evaluate and compare the complication rate of sedation with or without propofol regimen for percutaneous endoscopic gastrostomy (PEG) in a hospital in Thailand. Subjects and Methods. A total of 198 patients underwent PEG procedures by using intravenous sedation (IVS) from Siriraj Hospital,...

  • Successful new method of extracorporeal percutaneous endoscopic gastrostomy (E-PEG). Toyama, Yoichi; Usuba, Teruyuki; Son, Kyonsu; Yoshida, Seiya; Miyake, Ryou; Ito, Ryusuke; Tsuboi, Kazuto; Kashiwagi, Hideyuki; Tajiri, Hisao; Yanaga, Katsuhiko // Surgical Endoscopy;Nov2007, Vol. 21 Issue 11, p2034 

    Background: Although percutaneous endoscopic gastrostomy (PEG) has become popular for patients with swallowing disorders as a nutrition support or a decompressant of gastrointestine, perioperative complications associated with PEG have not decreased, especially peristomal...

  • Safety and Efficacy of Percutaneous Endoscopic Gastrostomy in Children. Marin, O. E.; Glassman, M. S.; Schoen, B. T.; Caplan, D. B. // American Journal of Gastroenterology;Mar1994, Vol. 89 Issue 3, p357 

    Objectives: To establish the safety and efficacy of percutaneous endoscopic gastrostomy (PEG) placement for nutritional support in children. Methods: The charts of 70 children who underwent the procedure between 1989 and 1992 were reviewed. Three of the 70 had repeat PEG placement. Patients...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics