Risk of Esophageal Cancer Following Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients

Abstract

Esophageal cancers account for majority of synchronous or metachronous head and neck cancers. This study examined the risk of esophageal cancer following percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients using the Taiwan National Health Insurance Research Database.From 1997 to 2010, we identified and analyzed 1851 PEG patients and 3702 sex-, age-, and index date-matched controls.After adjusting for esophagitis, esophagus stricture, esophageal reflux, and primary sites, the PEG cohort had a higher adjusted hazard ratio (2.31, 95% confidence interval [CI] = 1.09–4.09) of developing esophageal cancer than the controls. Primary tumors in the oropharynx, hypopharynx, and larynx were associated with higher incidence of esophageal cancer. The adjusted hazard ratios were 1.49 (95% CI = 1.01–1.88), 3.99 (95% CI = 2.76–4.98), and 1.98 (95% CI = 1.11–2.76), respectively.Head and neck cancer patients treated with PEG were associated with a higher risk of developing esophageal cancer, which could be fixed by surgically placed tubes.

Optimising nutrition support in patients with head and neck cancer

“…A subsequent review identified an additional four patients with gastrostomy site metastasis (total accumulative cases n=42) (Huang et al, 2013). This updated review of gastrostomy site seeding reported that in 97% of cases the pull technique was used and that 89% occurred when the tube was placed prior to treatment A recent retrospective cohort study in Taiwan also reports an increased oesophageal cancer risk (HR=2.31, p=0.02) in their patients with a gastrostomy (n=1851) compared to a matched control group of patients without a gastrostomy (n=3702) (Lin, Lin, Lee, Huang, & Chang, 2016). Theories have been proposed on the possible mechanism by which seeding occurs such as swallowing of tumour cells or lymphatic spread, but it has also been suggested that direct implantation may occur with the pull technique from the endoscope, and thus debate on the optimal method continues.…”