PWE-006 The T-piece pull technique removal of PEG buried bumpers – a quick novel endoscopic technique

Abstract

PEG and 15% RIG. The mean insertion time from diagnosis was 11 months (+/-14 months), with 30 day mortality 1.9%. Overall mortality was 87% with mean survival from diagnosis 23 months (+/-16 months).The majority of PEG insertions were arranged on dedicated lists with anaesthetic cover (83% vs 17%) compared with only a minority of RIG insertions (18% vs 82%). There was no significant difference between time to insertion (P = 0.78) and survival from diagnosis (P = 0.61) between the 2 cohorts. Conclusions Gastrostomy use in the South West is safe, with mortality rates below quoted literature. Gastrostomy practice differs between the 2 hospitals in the approach used but time to insertion and mean survival was not different. The authors intend to pursue a joint referral pathway for gastrostomy assessment. This would improve data collection quality, allowing future analysis of standardised variables to ascertain the most effective use of gastrostomies in these patients.

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

“…The push-pull methods have been widely published, sometimes with modifications. In the push-pull T-technique for example, the impacted inner bumper is released by simultaneous traction with a polypectomy snare and support using a surgical clamp (2,7,11).…”

“…The Buried Bumper Syndrome (BBS) was first described in the 1990s and is a rare complication of PEG placement. The reported incidence in literature ranges from 0.3% to 2.4% (1)(2)(3)(4)(6)(7)(8)(9)(10)(11)(12). The main etiological factor leading to BBS, is excessive traction between the external and internal bumper of the PEG-tube causing ischemia, necrosis and ulceration of the overlying gastric mucosa (1)(2)(3)(4)(6)(7)(8)(9)(10)(11)(12).…”

“…The reported incidence in literature ranges from 0.3% to 2.4% (1)(2)(3)(4)(6)(7)(8)(9)(10)(11)(12). The main etiological factor leading to BBS, is excessive traction between the external and internal bumper of the PEG-tube causing ischemia, necrosis and ulceration of the overlying gastric mucosa (1)(2)(3)(4)(6)(7)(8)(9)(10)(11)(12). This eventually may lead to partial transmural migration, where the bumper is still partly visible from within the gastric lumen (incomplete BBS), or to a complete migration through the gastric wall (complete BBS) (2,3).…”

“…The internal bumper can dislocate to anywhere along the PEG-tract: from the gastric mucosa to the skin surface. Risk factors for excessive traction are poor wound healing, overweight or rapid weight gain due to adequate enteral feeding, chronic cough, manipulation by unexperienced nursing staff and insertion of gauze under the external bumper (1)(2)(3)(4)(6)(7)(8)(9)(10)(11)(12).…”

“…Clinical symptoms vary greatly, ranging from abdominal discomfort to leakage around the gastrostomy (1)(2)(3)(4)(6)(7)(8)(9)(10)(11)(12). Whilst a completely buried bumper is easily recognized during endoscopy, we should be aware of early signs of BBS.…”