Abstract | April 4, 2022

Percutaneous Endoscopic Gastrostomy Seeding Metastatic Aerodigestive Cancer: A Fatal Complication of a Common Procedure

Presenting Author: Joshua A. Berko, B.S.,OMS-3, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL

Coauthors: Joshua A. Berko, OMS3, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL; Gregory W. Kunis, MS, OMS3, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL; Mark Casebolt, MD, Advent Health Ocala, FL.

Learning Objectives

  1. Describe a case of PEG placement seeding cancer;
  2. Examine the importance of this fatal complication of a common procedure;
  3. Identify the need for additional research in this area to identify risk factors and possibly prevent this complication.

Introduction: Percutaneous endoscopic gastrostomy (PEG) feeding is vital to maintain enteral nutrition during the treatment of head and neck cancers. PEG placement is a relatively safe procedure with low risk of complications. A rare but serious complication of PEG placement is the possibility of seeding the cancer during the PEG placement procedure. The most common sites of metastasis are the abdominal wall and stomach. To date, this is a relatively understudied phenomenon as there are only about 70 cases documented in the literature. We present a rare case of PEG tube seeding of an aerodigestive cancer to the abdominal wall.

Case Presentation: A 75-year-old female is being treated for esophageal adenocarcinoma with chemotherapy and radiation and had a PEG tube placed 5 months prior due to dysphagia. She now presents with severe pain, drainage, and erythema at PEG stoma site. A CT of the abdomen was performed and showed a large, rounded, soft tissue density measuring 6 x 5.5 x 4.5 cm extending inferiorly from the tube site within the anterior abdominal wall as well as new liver metastases. The differential diagnosis included infectious phlegmon, tumor implant, and extravasated contents. The patient demonstrated increasing tolerance for oral intake and once fully transitioned, underwent PEG removal and gastrostomy closure with abdominal wall mass resection and liver mass biopsy. Pathology of the abdominal and liver masses revealed poorly differentiated, metastatic adenocarcinoma.

Final/Working Diagnosis: Primary esophageal adenocarcinoma with abdominal wall and liver metastasis.

Management/Outcome/and or Follow-up/Conclusion: With diffuse metastasis, the prognosis is poor and the patient was recommended palliative care or transfer to tertiary site for diffuse surgical resection. The patient declined and requested to be discharged home once stable. Long-term outcomes from PEG seeded metastasis have shown a one-year survival rate of 35.5% with an overall mortality rate of 87.1%, and an average time to death from detection of PEG disease was 5.9 months. Additional research needs to be conducted to assess risk factors for PEG seeding examining PEG tube placement techniques that minimize risk of this fatal complication.

References and Resources:

  1. Huang, A.T., Georgolios, A., Espino, S. et al. Percutaneous endoscopic gastrostomy site metastasis from head and neck squamous cell carcinoma: case series and literature review. J of Otolaryngol – Head & Neck Surg 42, 20 (2013). https://doi.org/10.1186/1916-0216-42-20
Posted in: Medical Oncology17 Surgery & Surgical Specialties35