Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy

Abstract

Percutaneous endoscopic gastrostomy (PEG) is a widely used method of nutrition delivery for patients with long-term insufficiency of oral intake. The PEG complication rate varies from 0.4% to 22.5% of cases, with minor complications being three times more frequent. Buried bumper syndrome (BBS) is a severe complication of this method, in which the internal fixation device migrates alongside the tract of the stoma outside the stomach. Excessive compression of tissue between the external and internal fixation device of the gastrostomy tube is considered the main etiological factor leading to BBS. Incidence of BBS is estimated at around 1% (0.3%-2.4%). Inability to insert, loss of patency and leakage around the PEG tube are considered to be a typical symptomatic triad. Gastroscopy is indicated in all cases in which BBS is suspected. The depth of disc migration in relation to the lamina muscularis propria of the stomach is critical for further therapy and can be estimated by endoscopic or transabdominal ultrasound. BBS can be complicated by gastrointestinal bleeding, perforation, peritonitis, intra-abdominal and abdominal wall abscesses, or phlegmon, and these complications can lead to fatal outcomes. The most important preventive measure is adequate positioning of the external bolster. A conservative approach should be applied only in patients with high operative risk and dismal prognosis. Choice of the method of release is based on the type of the PEG set and depth of disc migration. A disc retained inside the stomach and completely covered by the overgrowing tissue can be released using some type of endoscopic dissection technique (needle knife, argon plasma coagulation, or papillotome through the cannula). Proper patient selection and dissection of the overgrowing tissue are the major determinants for successful endoscopic therapy. A disc localized out of the stomach (lamina muscularis propria) should be treated by a surgeon.

Complications according to underlying disease in children undergoing video-assisted gastrostomy

“…Buried bumper syndrome, in which the internal fixation device migrates alongside the tract of the stoma outside the stomach, is known to be a severe complication to PEG placement 25 .…”

Buried Bumper Syndrome: A Case Report of a Rare Complication of Percutaneous Endoscopic Gastrostomy

“…BBS may present with bleeding, perforation [1], peritonitis, abscess and phlegmon [7], but also, rarely, as necrotizing fasciitis [11], rectus abdominis necrosis [12], or with co-existence of encephalopathy and high anion gap metabolic acidosis [13]; these complications could be potentially lethal. Microbes isolated from the tube or the wound are rarely described in the literature, but they can include Klebsiella pneumonia and Candida vulgaris [7].…”

“…Its incidence ranges between 0.3% and 2.4% [2], but, according to others, it can occur in 0.9% to over 8% [3] of adult patients with PEG. Although this complication is considered as late one, early cases have also been described [4], probably by vigorous traction of the cannula or tightness of the external bolster [1].…”

“…However, complications of the procedure minor or major are referred and present in a rate varying from 0.4% to 22.5% [1].…”

Direct Puncture Endoscopic Assisted Gastrostomy: An Alternative Technique, Case Report

“…Procedure that could be used not only in this patients but In case of missing endoscopy kit resources, but having the elements of the open technique without the need of a laparotomy [13, 24,30,39]. This technique is easily reproducible, cost are the same or below endoscopic or laparoscopic technique and any surgeon with endoscope help can perform this technique without major complications just by following basic security and skill used in any surgery.…”