Incidence of implantation metastasis and other gastrostomy tube-related complications among cancer patients: a single center experience

Aims Percutaneous endoscopic gastrostomy (PEG) is a widely used medical procedure for establishing enteral feeding access in patients requiring long-term nutritional support. When performed in cancer patients, the risk for tumor cell seeding to the gastrostomy site, while low, remains a notable concern. The aim of this study is to evaluate the incidence of PEG site metastasis and other PEG placement-related complications in our cohort.

Methods We retrospectively reviewed a total of 963 cancer patients, who underwent PEG placement at Heidelberg University Hospital between 2007 and 2023. Patient demographics, procedure technique, postprocedural complications and patient outcomes were assessed.

Results In total, 963 patients were feasible to analysis (mean age 64 years, 66.8% males). The most common primary diagnosis was cancer of the head and neck, accounting for 81.7% of the cases, followed by esophageal cancer at 11.7%. 94.5% of the patients (n=910) underwent the pull technique, 5.4% (n=52) the direct-puncture technique, and 0.1% (n=1) underwent a hybrid technique for PEG placement. The pull technique was predominantly favored for patients undergoing treatment with no signs of active tumor, due to its lower risk of complications, ease of handling, and greater patient preference. The technical success rate among all patients was 100%. The mean follow-up was 29.3 months (± SD 33.1). A PEG site metastasis was observed in only one of the included patients (0.1%). The patient underwent PEG insertion prior to a combined radiochemotherapy for mucoepidermoid carcinoma of the larynx. 19 months later a metastasis was found during an upper endoscopy and was confirmed by histopathology. A total of 20 patients (2.1%) had peri-interventional complications, such as peritonitis (n=12), tube dislocation (n=3) and bleeding (n=3). Twenty-seven (2.8%) patients had interval complications. The most common were buried bumper syndrome (n=9) and dislocation of the tube (n=7). There was no death related to the PEG procedure.

Conclusions PEG is a well-established procedure with a low risk of major adverse events. Though rare, the risk of tumor implantation at the PEG insertion site as iatrogenic complication exists, emphasizing the importance of appropriate patient selection, correct technique and regular monitoring of the PEG site.

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Artikel online veröffentlicht:
27. März 2025