Objective: Systematically review all reported cases of stomal site metastases after PEG placement in patients with head and neck cancer
Methods: Ovid MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register were queried. Results. Systematic review yielded 104 unique cases of stomal PEG site metastasis. The majority of cases occurred in patients with pharyngoesophageal tumors (76.0%), at advanced (T3/T4) stage (77.0%), with pathological evidence of SCC (87.8%), and were poorly differentiated. In all except one case, the PEG was administered via the “pull” mechanism. Average time from PEG placement to diagnosis of metastasis was 7.63 ± 4.80 months, average tumor size on detection was 4.5 ± 2.06 cm, and average length of survival after detection was 7.49± 6.40 months.
Conclusions. Stomal metastasis to the percutaneous endoscopic gastrotomy (PEG) tube in head and neck cancer patients is a rare but serious complication. Risk factors include advanced stage, pharyngoesophageal primary cancer, SCC histology, and moderately/poorly differentiated cancer. Risk of developing stomal metastasis may be reduced through substitution of the pull-string with the push-guidewire PEG technique.
- Recognize that stomal metastasis to the percutaneous endoscopic gastrotomy (PEG) tube in head and neck cancer patients is a rare but serious complication of the procedure
- Identify risk factors for stomal metastases including advanced stage, pharyngoesophageal primary cancer, squamous cell histology, and moderately/poorly differentiated cancer.
- Develop a thorough rationale for using pull-string versus push-guidewire PEG placement technique for patients with head and neck cancer
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Corresponding Author: Dr. Jennifer Siu
Senior Author: Dr. Antoine Eskander
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