Cancer metastasis at percutaneous endoscopic gastrostomy stomata is related to the hematogenous or lymphatic spread of circulating tumor cells

Percutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive oropharyngeal and esophageal tumors. PEG tube placement is considered safe, and complications are infrequent. One complication, although rare, that is being increasingly reported is the metastasis of cancer at PEG stomata. Herein, a case of metastasis of an esophageal cancer at a PEG stoma is described. Although it has been previously suggested that cancer metastasis is due to direct seeding of the stoma, an analysis of the literature suggests that this phenomenon is related to the hematogenous or lymphatic spread of cancer cells to a susceptible site.