Endoscopic management of buried bumper syndrome using the Balloon Dilation Pull (BDP) technique: a multicenter analysis

Abstract

Background and study aims: Buried bumper syndrome (BBS) may complicate percutaneous endoscopic gastrostomy placement. In these patients, endoscopic treatment ought to be considered. Various approaches have been published, ranging from dissectionbased techniques to novel dedicated devices, although the evidence supporting the use of the Balloon Dilation Pull (BDP) technique has been limited to single case reports. The aim of this paper is to assess the feasibility, efficacy and safety of the systematic use of the BDPtechnique for the endoscopic treatment of BBS. Patients and methods: We performed a retrospective multicenter analysis of prospectively collected data from all patients treated with the BDP-technique between January 2011 and November 2021. Results: In total, 26 patients were identified (median age 72 (SD ± 13) years, 74% male, 84.6% underlying neurological disease). Technical success was achieved in 92.3%, with a median procedure time of 17.5 minutes (range 5-27). Adverse events were identified in 3.8% of patients (N=1, aspiration, ASGE lexicon severity grade: moderate). Conclusions: Our experience suggests that the BDP-technique is highly efficacious and safe, using accessories readily available in every endoscopic unit. Given the limited procedure time and tools required, this procedure has the potential to further optimize patient care in the context of BBS.

Essential reading from the editor’s desk

“…Another comprehensive review was written by Hannes Ruymbeke and colleagues from multiple Belgian centers on secondary anal fissures, an important topic, that many physicians are less well-versed in (9). Also in this issue, Maly and colleagues describe their experience with the 'balloon dilation pull' technique for the treatment of buried bumper syndrome in patients with a percutaneous endoscopy gastrostomy (PEG) (10). Technical success was achieved in 24 of 26 patients (92%) with a low incidence of adverse events (1 aspiration pneumonia and 1 patient with limited local bleeding).…”