Interdisciplinary Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Endoscopy. 2013 Jul;45(7):526-31. doi: 10.1055/s-0033-1344023. Epub 2013 Jun 18.
Insertion of a percutaneous endoscopic gastrostomy (PEG) is standard care for many patients with oropharyngeal (ENT) and esophageal malignancies in order to ensure enteral feeding. The current pull-through insertion technique involves direct contact with the tumor and case reports have demonstrated the presence of metastases at insertion sites. The aim of the current study was to prospectively evaluate the risk of malignant cell seeding and the development of abdominal wall metastases after PEG placement.
A total of 50 consecutive patients with ENT/esophageal tumors were included. After PEG placement (40 pull-through technique, 10 direct insertion), brush cytology was taken from the PEG tubing and the transcutaneous incision site. A second cytological assessment was performed after a follow-up period of 3 - 6 months.
In total, 26 patients with ENT cancer, 13 with esophageal cancer, and one with esophageal infiltration of lung cancer underwent pull-through PEG placement with no immediate complications. Cytology following brushing of tubing and incision sites demonstrated malignant cells in 9 /40 cases (22.5 %). Correlation analyses revealed a higher rate of malignant seeding in older patients and in those with higher tumor stages. At follow-up, cytology was undertaken in 32 /40 patients who had undergone pull-through PEG placement. Malignant cells were present in three on cytology, resulting in a metastatic seeding rate of 9.4 %.
This study showed that malignant cells were present in 22.5 % of patients immediately after pull-through PEG placement; local metastases were verified at follow-up in 9.4 %, all of which were from esophageal squamous cell carcinoma. This risk is particularly high in the older age group and in patients with higher tumor stages. Therefore, pull-through PEG placement should be avoided in these patients and direct access PEG favored instead.
经皮内镜胃造口术（PEG）的插入是许多口咽（耳鼻喉科）和食管恶性肿瘤患者的标准治疗方法，以确保肠内喂养。目前的经皮内镜胃造口术插入技术涉及与肿瘤的直接接触，病例报告已经证明在插入部位存在转移。本研究的目的是前瞻性评估 PEG 放置后恶性细胞播种和腹壁转移的风险。
共纳入 50 例耳鼻喉科/食管肿瘤患者。PEG 放置后（40 例经皮内镜胃造口术，10 例直接插入），从 PEG 管和经皮切口处采集刷取细胞学标本。在 3-6 个月的随访期后进行第二次细胞学评估。
共有 26 例耳鼻喉癌患者、13 例食管癌患者和 1 例肺癌食管浸润患者接受了经皮内镜胃造口术，无即时并发症。对管和切口部位刷取细胞学标本的分析显示，40 例中有 9 例（22.5%）存在恶性细胞。相关性分析显示，老年患者和肿瘤分期较高的患者恶性播种率较高。在随访中，对 32 例接受经皮内镜胃造口术的患者进行了细胞学检查。细胞学检查中有 3 例存在恶性细胞，转移播种率为 9.4%。
本研究表明，经皮内镜胃造口术放置后立即有 22.5%的患者存在恶性细胞；在随访中，有 9.4%的患者证实存在局部转移，均来自食管鳞状细胞癌。这种风险在老年患者和肿瘤分期较高的患者中尤其高。因此，应避免在这些患者中使用经皮内镜胃造口术，而应首选直接进入经皮内镜胃造口术。
