Metastasis to the percutaneous endoscopic gastrostomy site from hypopharyngeal cancer-a case report and review of the literature-

Abstract

Percutaneous endoscopic gastrostomy (PEG) is frequently used in patients with hypopharyngeal cancer to establish enteral access for feeding. In this report we describe a 59–year–old man with advanced squamous cell carcinoma (SCC) of the hypopharynx who had undergone placement of a PEG button by "pull" technique for dysphagia. Three months later, the patient developed metastatic SCC at the PEG site.
Cancer metastasis to the PEG site is a very rare but serious complication after this procedure. Fifty–five cases of PEG site metastasis in patients with head and neck cancer have been reported in the English literature, and only two cases in the Japanese literature. Most of the patients underwent PEG placement by means of the "pull" technique. The direct seeding through instrumentation might be the most likely cause. To prevent this rare complication, other techniques such as open gastrostomy need to be considered, and long–term close follow–up after PEG placement is recommended.