Overtube-assisted PEG tube placement protects head and neck cancer patients.

PEG Tube Placement: Is There a Safer Way for Head and Neck Cancer Patients?

Author's portrait.
Theo Raines in Health & Wellness December 2025 • 4 min read.

"Overtube-assisted PEG placement shows promise in reducing complications for vulnerable patients. Find out if this method could be right for you or your loved one."


For individuals facing malnutrition, especially those battling head and neck cancer (HNC), percutaneous endoscopic gastrostomy (PEG) tubes are a lifeline, providing essential nutritional support. These tubes, inserted through the skin into the stomach, ensure patients receive the nutrients they need when swallowing becomes difficult or impossible.

However, traditional PEG tube placement techniques aren't without risks, particularly for HNC patients. One concerning complication is peristomal metastasis, where cancer cells spread to the insertion site. While relatively rare, this can significantly impact prognosis.

Now, a recent study investigates a modified approach: overtube-assisted PEG placement. This technique uses a protective tube during the procedure, potentially minimizing the risk of complications like peristomal metastasis. Let's delve into the findings and explore whether this method offers a safer alternative for HNC patients.

Overtube-Assisted PEG: A Shield Against Complications?

Overtube-assisted PEG tube placement protects head and neck cancer patients.

The primary concern with traditional PEG tube placement in HNC patients is the potential for tumor cells to spread during the procedure. The "pull" technique, commonly used, involves pulling the tube through the mouth and esophagus, which could dislodge malignant cells and seed them at the insertion site.

Overtube-assisted PEG aims to address this by creating a barrier between the tube and the oral cavity/esophagus. The overtube acts as a protective sheath, preventing direct contact and reducing the risk of tumor cell translocation.

  • Reduced Peristomal Infection: Overtubes prevent contact between the PEG tube and the bacteria-rich oral cavity, minimizing infection risk.
  • Potentially Prevents Cutaneous Metastasis: By creating a physical barrier, the overtube reduces the chance of tumor cells implanting at the PEG site.
  • Technically Feasible and Safe: Modern overtube designs and insertion techniques have made the procedure safer, minimizing the risk of complications like esophageal injury.
Researchers at Westmead Hospital in Australia conducted a retrospective study to evaluate the feasibility and safety of overtube-assisted PEG placement in HNC patients. The study included 53 patients who underwent the procedure between 2011 and 2013. The results offer encouraging insights into the potential benefits of this modified technique.

The Future of PEG Tube Placement for HNC Patients

The Westmead Hospital study provides valuable evidence supporting the use of overtube-assisted PEG placement in HNC patients. The researchers successfully placed PEG tubes in all 53 patients using this technique, with a low rate of complications and no observed cases of overt cutaneous metastasis during a median follow-up of 16 months.

While these findings are promising, it's important to note the study's limitations, including its retrospective design and relatively small sample size. Larger, prospective studies are needed to confirm these results and further evaluate the long-term benefits of overtube-assisted PEG placement.

For HNC patients requiring PEG tubes, discussing the potential benefits and risks of overtube-assisted placement with their healthcare team is crucial. This approach may offer a safer alternative, minimizing the risk of complications and improving overall outcomes. As research continues, overtube-assisted PEG could become the standard of care for this vulnerable patient population.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1155/2015/612610, Alternate LINK

Title: Feasibility And Safety Of Overtubes For Peg-Tube Placement In Patients With Head And Neck Cancer

Subject: Gastroenterology

Journal: Gastroenterology Research and Practice

Publisher: Hindawi Limited

Authors: Crispin O. Musumba, Julia Hsu, Golo Ahlenstiel, Nicholas J. Tutticci, Kavinderjit S. Nanda, David Van Der Poorten, Eric Y. Lee, Vu Kwan

Published: 2015-01-01

Everything You Need To Know

1

What are PEG tubes and why are they used?

Percutaneous endoscopic gastrostomy (PEG) tubes are essential for providing nutritional support to individuals, particularly those with head and neck cancer (HNC), when swallowing is compromised. These tubes are inserted through the skin directly into the stomach, ensuring patients receive vital nutrients. The use of PEG tubes is crucial for managing malnutrition and supporting overall health and recovery in this vulnerable patient population.

2

What are the risks associated with traditional PEG tube placement?

Traditional PEG tube placement carries risks, especially for head and neck cancer (HNC) patients. The 'pull' technique, commonly employed, may potentially spread cancer cells to the insertion site, leading to peristomal metastasis. This metastasis is a serious complication that can negatively affect the patient's prognosis. The risk highlights the need for safer alternatives in PEG tube placement.

3

How does overtube-assisted PEG placement work?

Overtube-assisted PEG placement involves using a protective tube, or overtube, during the procedure. This overtube acts as a barrier, preventing direct contact between the PEG tube and the oral cavity and esophagus. This method aims to reduce the risk of complications such as peristomal metastasis and infection, by minimizing the potential for tumor cell translocation and exposure to bacteria.

4

Why is overtube-assisted PEG placement important?

The significance of overtube-assisted PEG placement lies in its potential to improve outcomes for head and neck cancer (HNC) patients. By reducing the risk of peristomal metastasis and infection, this technique may lead to better patient outcomes. Studies, such as the one conducted at Westmead Hospital, are crucial in evaluating the feasibility, safety, and benefits of this modified approach for HNC patients.

5

What did the Westmead Hospital study find about overtube-assisted PEG placement?

The Westmead Hospital study demonstrated that overtube-assisted PEG placement is technically feasible and safe for head and neck cancer (HNC) patients. The study showed successful PEG tube placement in all 53 patients with a low rate of complications and no observed cases of cutaneous metastasis during the follow-up period. This research supports the use of this modified technique.

Newsletter Subscribe

Subscribe to get the latest articles and insights directly in your inbox.