Percutaneous endoscopic gastrostomy (PEG) is a safe and simple procedure used to provide enteric nourishment in patients with non-operable, constricting, malignant tumors of the oropharynx or esophagus.
However, abdominal wall metastases may develop as a late complication, the mechanism of which is controversial.
In this study, a research team from Germany assessed 2 patients, in whom abdominal wall metastases had developed between 9 and 14 months following PEG.
Both these patients suffered from an advanced esophageal carcinoma.
In 1 patient surgery was necessary due to the size of the metastasis; this was followed by several weeks of hospital treatment.
However, the second patient was in a pre-final condition and no surgical procedure was performed.
The researchers reviewed the current literature to assess whether, in certain cases, an operative gastrostomy should be preferred to a PEG.
The team found that the reason for abdominal wall metastases may be direct tumor seeding.
Dr Thermann's team concluded, "In certain cases, to avoid a possible metastasis resection, an operative gastrostomy should be considered".
"This is particularly relevant if the tumor is constricting with a high risk of losing tumor cells".
"If possible, a minimal-invasive method is to be preferred".