Cancer metastasis to a percutaneous gastrostomy site

Predictive factors for early mortality after percutaneous endoscopic and radiologically-inserted gastrostomy

BACKGROUND

Gastrostomy insertion is of benefit to selected patients, but 30-day mortality is as high as 54% in some patient groups. The current study examines risk factors associated with 30-day mortality in a cohort of patients who underwent percutaneous endoscopic gastrostomy (PEG) or radiologically-inserted gastrostomy (RIG) in a district general hospital over a 2.5 year period.

METHODS

A retrospective review of case notes was performed for all patients who underwent a PEG (n=53) or RIG (n=40) insertion in the period January 2009-July 2011. PEG/RIG re-insertions were excluded. Demographic, clinical, and biochemical data were analysed. Multivariate regression analysis was used to identify risk factors for early mortality after gastrostomy insertion.

RESULTS

The indications for gastrostomy insertion were similar in the PEG and RIG groups and included mainly dysphagic stroke, chronic neuromuscular disease and head and neck cancer. The patients in the RIG group were older and had a higher incidence of cardiovascular co-morbidities. The overall 30-day mortality was 11% in the PEG and 40% in the RIG group. The multivariate regression analysis suggested that cardiovascular co-morbidities and RIG insertion were independent risk factors for early mortality. The main cause of death 30 days after gastrostomy insertion was pneumonia, which was significantly more common in the RIG group.

CONCLUSIONS

Our data suggest that PEG should be the procedure of choice when considering gastrostomy insertion and RIG should be reserved as a second-line approach for cases in which PEG is technically difficult or contraindicated.

Percutaneous endoscopic gastrostomy site metastasis from head and neck squamous cell carcinoma: case series and literature review

Objectives

To present our experience with head and neck squamous cell carcinoma (HNSCC) seeding of percutaneous endoscopic gastrostomy (PEG) sites and to review all reported cases to identify risk factors and develop strategies for complication avoidance.

Materials and methods

The records of 4 patients with PEG site metastasis from HNSCC were identified from the authors’ institution. Thirty-eight further cases were reviewed following a PubMed search and evaluation of references in pertinent articles.

Results

Review of 42 cases revealed the average time from PEG to diagnosis of metastatic disease to be 8 months. Average time to death from detection of PEG disease was 5.9 months. One-year survival following PEG metastasis was 35.5% with an overall mortality of 87.1%.

Conclusion

PEG site metastatic disease portends a poor prognosis. Early detection and aggressive therapy may provide a chance of cure. Changes in PEG technique or in timing of adjunctive therapies are possible avenues in further research to prevent this complication.

Stomal metastases complicating percutaneous endoscopic gastrostomy: CT findings and the argument for radiologic tube placement

OBJECTIVE

This article describes the CT appearance of metastatic implantation at the percutaneous endoscopic gastrostomy (PEG) tract in patients with malignancy of the upper aerodigestive tract. Cumulative data from previous case reports are also considered for insight into causes of metastasis and the implications for gastrostomy placement in these patients.

CONCLUSION

CT showed lobulated soft tissue involving the entire abdominal wall PEG tract in all proven cases. CT is an effective method for evaluation because the tumor burden lies predominately in the abdominal wall and not at the entry or exit site. The stomal implant is often the only site of metastatic disease at presentation. In general, CT findings of mildly increased soft tissue along the PEG tract are nonspecific, but a lobulated mass is highly suspicious for tumor implantation, especially if the one-sided thickness exceeds 1 cm. The preponderance of evidence from the existing literature points to direct tumor implantation during endoscopic placement as the likely cause (rather than hematogenous spread). This conclusion would support the alternative of radiologic tube placement in these patients.