**1. Introduction**

In 2018, global cancer statistics reported that the incidence of esophageal cancer and mortality were 572,000 new cases and 509,000 deaths, ranking seventh and sixth of all cause cancer morbidity and mortality, Thus, esophageal cancer is a significant global health problem [1]. Most cases present late with advanced disease, especially in the developing countries [1]. Local tumor growth leads to esophageal lumen narrowing and dysphagia and results in increasing difficulty with eating solid food, weight loss and worsening nutritional status. Improving nutritional status is a key factor in determining patient's ability to perform activities of daily living, tolerability of multimodal anticancer treatment, long-term outcomes, and quality of life [2–6].

Percutaneous endoscopic gastrostomy (PEG) is a safe and effective minimally invasive option [7, 8]. Two primary PEG techniques are used worldwide: the pull and push/introducer methods [9, 10]. The pull technique was introduced first and more widely used but cancer seeding through the gastrostomy stroma is a rare but

concern disadvantage [11–15]. Refining the pull technique led to the development of the push or introducer technique to avoid tumor seeding to the stroma [9, 16–18].
