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Gastrostomy Site Metastasis: How Common Is It?

Vanessa M. Shami, MD, FASGE, reviewing Siu J, et al. Gastrointest Endosc 2020 Jan 8.

More than half of individuals with upper aerodigestive tract (UADT) malignancies, including esophageal as well as all head and neck cancers, are nutritionally deficient. Many of these patients are referred for percutaneous endoscopic gastrostomy (PEG) placement. There has always been a theoretical risk of direct seeding of the gastric mucosa at time of PEG placement; however, the frequency of this phenomenon is not well established. This meta-analysis assessed the rate of metastasis to gastrostomy sites from UADT malignancies, as well as a secondary aim to compare rates for both the push and pull PEG techniques.

A pooled analysis showed an overall event rate of gastrostomy site metastasis to be 0.5% (95% confidence interval [CI], 0.4%-0.7%). Upon review of the literature, there were a total of 121 independent cases of UADT malignancies with subsequent gastrostomy site metastasis. PEG placement occurred prior to therapy in 92% of cases, and patients were diagnosed with metastasis 7.8 ± 4.9 months after initial gastrostomy placement, with an average survival of 7.26 (standard deviation, 6.23) months. The majority of cases were Stage 3 (21 [24.4%]) or Stage 4 (58 [67.4%]), with lymph node involvement in more than half of these cases. When comparing the push versus pull PEG techniques, subgroup analysis showed an event rate of 0.56% (95% CI, 0.40%-0.79%) with the pull technique and 0.29% (95% CI, 0.15%- 0.55%) with the push technique.

Comment:
Gastrostomy site metastasis is estimated at 0.5% of patients with UADT malignancies, particularly advanced stages of malignancy. These findings were consistent with a direct seeding mechanism resulting in metastasis. The most important takeaway from this analysis is that if PEG is placed before administration of treatment with curative intent, there should be consideration of choosing the push technique over the pull technique when technically feasible. Given the limited data available on this topic, it will be important to have higher detection and reporting of PEG site metastasis in future literature.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Vanessa M. Shami, MD, FASGE

Citation(s):

Siu J, Fuller K, Nadler A, et al. Metastasis to gastrostomy sites from upper aerodigestive tract malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2020 Jan 8. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.12.045)

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