A new endoscopic technique for the buried bumper syndrome

Leung, Edmund; Chung, L.; Hamouda, A.; Nassar, Ahmad H M

doi:10.1007/s00464-007-9224-x

Cited by 13 publications

(8 citation statements)

References 12 publications

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“…10 Several methods have been described to treat this condition. These methods include endoscopic removal of the PEG tube, 7,9,11 surgical removal, 3,6,12 laparoscopic removal, 13 or prolonged application of external traction. 14 Each of these methods has major disadvantages.…”

Section: Discussionmentioning

confidence: 99%

Buried Bumper Syndrome: Cut and Leave It Alone!

et al. 2008

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Buried bumper syndrome (BBS) occurs due to the overgrowth of gastric mucosa over the inner bumper of a gastrostomy tube. Various therapeutic approaches have been described for the management of BBS. However, no standardized clinical protocol deals with this complication. The authors describe their experience of dealing with BBS. Case notes of the patients undergoing percutaneous endoscopic gastrostomy (PEG) between February 2002 and December 2007 at their institute were reviewed retrospectively, and cases of BBS were analyzed. During this 71-month period, 356 PEG procedures were preformed. Seven patients with BBS were identified from the case note review (incidence of 1.97%). Attempts at endoscopic removal of the buried bumper were made but unfortunately failed. In view of the patients' associated comorbidity, the buried bumpers in these patients were left in situ, and a new PEG was inserted adjacent to the first site in 6 individuals. In 1 patient, a jejunal extension tube was inserted through the original PEG tube for feeding. No complications from the buried bumper arose in these patients during a median follow-up of 18 months (range, 1-46 months). Some patients being fed by a PEG tube are in poor general health and have significant comorbidities. They are therefore poor candidates for surgical or endoscopic removal of a buried bumper. In such patients, leaving the internal bumper in situ should be considered as a relatively safe treatment option.

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Section: Discussionmentioning

confidence: 99%

Buried Bumper Syndrome: Cut and Leave It Alone!

et al. 2008

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“…A variety of management options for BBS have been described, including endoscopic,2 5 6 8 surgical3 9 or laparoscopic,10 11 replacement, or insertion of a jejunal extension tube 1. However, such methods carry a risk of complications, and therefore opportunities to reduce incidence of BBS should be sought where possible.…”

Section: Introductionmentioning

confidence: 99%

Observed high incidence of buried bumper syndrome associated with Freka PEG tubes

Dowman¹,

Ditchburn²,

Chapman³

et al. 2014

Frontline Gastroenterol

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BackgroundBuried bumper syndrome (BBS) is an uncommon but significant complication of percutaneous endoscopic gastrostomy (PEG), which occurs due to overgrowth of gastric mucosa over the inner bumper of the gastrostomy tube. A high incidence of BBS was observed in patients with Freka PEG tubes.ObjectiveTo review case numbers of BBS and confirm the observed association with Freka tubes to determine whether change of practice should be considered.DesignData was collected on the number of cases of BBS reported to the community nutrition team Birmingham, UK. Data on type of PEG kit and total number of PEGs inserted between 2009 and 2013 were collected. The electronic endoscopy reporting database was used to compare case numbers of BBS in our Trust in years when Corflo and Freka PEG tubes were used, respectively. Data from our Trust were also compared with that from a Trust using Corflo only.ResultsFifty-eight cases of BBS were reported in the area covered by the Birmingham community nutrition team between 2009 and 2013, all of which were associated with Freka PEG tubes. An estimated 1000–1200 PEGs were inserted during this period, representing an incidence of BBS of 4.8–5.8%. No cases of BBS occurred over the same period in the comparison Trust (451 Corflo PEGs inserted).ConclusionsOur review confirmed our observation of an increased risk of BBS with Freka PEG tubes. Clinicians should be aware of our findings when deciding which brand of PEG tube to insert, particularly in patients with a previous history of BBS.

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“…16 In the literature there are also some new techniques such as inserting a stainless steel probe or a ureteric catheter from external PEG opening and pushing the bumper buried into the wall of stomach and grasping the PEG tube by using a snare endoscopically. 17,18 However, if the buried tube cannot be removed by manual or endoscopic methods or if the patient's condition is complicated by peritonitis and abscess, surgical intervention with laparotomy or a laparoscopic approach is required. 19 Several factors have been proposed that contribute to the development of BBS.…”

Section: Discussionmentioning

confidence: 99%

Acute Buried Bumper Syndrome with Gastric Perforation and Peritonitis: A Rare Complication of Percutaneous Endoscopic Gastrostomy: Case Report

Akarsu¹,

Kantar²

2012

Turkiye Klinikleri J Med Sci

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ercutaneous endoscopic gastrostomy (PEG) is a broadly accepted procedure of enteral feeding for patients with inadequate oral intake. The side effects and complications of PEG are becoming more evident with its increasing use. Buried bumper syndrome (BBS) is one of the rare complications of PEG and occurs when internal bumper of the PEG tube becomes lodged anywhere between the gastric wall and the skin along the PEG tract. It is considered to be a late complication and becomes apparent months to years after PEG placement.1 Here, we report an unusual case of BBS with a gastric perforation at the internal gastrostomy site and peritonitis that occurred on the third day of placement. The contributing factors, preventive measures and treatment recommendations are also reviewed briefly. A AB BS ST TR RA AC CT T Percutaneous endoscopic gastrostomy (PEG) is a broadly accepted procedure of enteral feeding for patients with inadequate oral intake. The side effects and complications of PEG are becoming more evident with its increasing use. Here, we report a case of buried bumper syndrome, gastric perforation and peritonitis after PEG. In our case, perforated area was closed endoscopically by using hemoclips. The patient was treated with intravenous broad spectrum antibiotics for 10 days and fed by parenteral nutrition. The patient responded well to medical treatment therefore there was not any need for a surgical exploration. Follow up endoscopy was performed 15 days later which showed closure of the perforation area. A new PEG tube was inserted 1 month later.K Ke ey y W Wo or rd ds s: : Peritonitis; endoscopy, gastrointestinal Ö ÖZ ZE ET T Perkütan endoskopik gastrostomi (PEG) ağızdan gıda alımı yetersiz olan hastalarda geniş kabul görmüş bir işlemdir. Artan kullanımla birlikte PEG'in yan etkileri ve komplikasyonları da daha belirgin hale gelmektedir. Burada PEG'den sonra gelişen gömülmüş tampon sendromu, mide perforasyonu ve peritonit olgusunu sunuyoruz. Olgumuzda perfore alan hemoklipler kullanarak endoskopik olarak kapatıldı. Hasta 10 gün boyunca intravenöz geniş spektrumlu antibiyotiklerle tedavi edildi ve parenteral beslendi. Hasta medikal tedaviye iyi yanıt verdi, böylece cerrahi eksplorasyona gerek kalmadı. Onbeş gün sonra takip endoskopisi yapıldı ve perforasyon alanının kapandığı görüldü. Bir ay sonra yeni bir PEG tüpü yerleştirildi.A An na ah ht ta ar r K Ke el li im me el le er r: : Peritonit; endoskopi, gastrointestinal T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 12 2; ;3 32 2( (6 6) ): :1 17 79 91 1--5 5

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A new endoscopic technique for the buried bumper syndrome

Abstract: A PEG tube in a patient with buried bumper syndrome can be safely removed endoscopically, without a skin incision or gastric wall disruption. A novel, simple, and safe endoscopic removal technique is described.

Cited by 13 publications

References 12 publications

Buried Bumper Syndrome: Cut and Leave It Alone!

Buried Bumper Syndrome: Cut and Leave It Alone!

Observed high incidence of buried bumper syndrome associated with Freka PEG tubes

Acute Buried Bumper Syndrome with Gastric Perforation and Peritonitis: A Rare Complication of Percutaneous Endoscopic Gastrostomy: Case Report

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