Abdominal wall metastasis following percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become a widely used method for nutritional support, particularly in patients with advanced head and neck carcinomas. Since the method is easy and widely established it is necessary to assess possible complications, even rare ones. In this paper we report on two patients with vaccination metastasis following PEG insertion. Both patients had advanced squamous cell carcinoma of the head and neck or the upper esophagus. In three patients previous bougienage was performed, because of considerable stenosis of the pharynx and/or esophagus. Fast-growing metastases were found at the site of PEG insertion, with and without involvement of the gastric wall. In neither case was abdominal wall metastasis the cause of death. There is a small but definite risk of tumor seeding into the abdominal wall after PEG insertion for obstructive malignant tumors. The clinical impact of this finding, however, is still undefined and needs further investigation.