Abdominal wall metastasis as a complication of percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become an important adjunct i n the care of head and neck cancer patients. in the literature of the last 10 years, 16 cases of abdominal wall metastasis after PEG implantation were reported. We performed 387 PEG procedures in patients with head and neck cancers. In this paper, we describe two patients with advanced head and neck cancers wh o underwent PEG prior to cancer therapy and developed metastatic cancer at the PEG site 3 or 4 months later. Although the mechanism of spread cannot be confirmed, direct seeding from p assage through the cancer seems likely. Methods of establishing enteral acc ess which avoid tumor-contaminated fields, such as the use of an overtube d uring conventional PEG or PEG procedure after tumor resection, may be appro priate in head and neck cancer patients. Another possibility of origin is t he hematogenous spread of cancer cells from metastases on the abdominal wal l.