Small bowel obstruction caused by intraluminal migration of retained percutaneous endoscopic gastrostomy internal bumper

Abstract

Retained internal bumper is potentially dangerous and we recommend endoscopic retrieval of such flange.

Enteral Access Devices: Types, Function, Care, and Challenges

“…When the detached remnant (bolster, disc, bumper, mushroom, or dome) is allowed to remain the stomach, it is assumed that it would pass with stool. However, there have been reports of trapping of the remnant piece in the pylorus or intestinal wall, obstruction of the intestine, or upward migration of the remnant leading to esophageal obstruction . In these cases, retention of the remnant piece has led to untoward GI symptoms, respiratory symptoms, need for further endoscopic or surgical procedures, and at times death.…”

“…However, there have been reports of trapping of the remnant piece in the pylorus or intestinal wall, obstruction of the intestine, or upward migration of the remnant leading to esophageal obstruction. [110][111][112][113][114] In these cases, retention of the remnant piece has led to untoward GI symptoms, respiratory symptoms, need for further endoscopic or surgical procedures, and at times death. To avoid these untoward complications with the traction pull technique, endoscopic retrieval of the internal (bolster, disc, bumper, mushroom, or dome) should be immediately attempted if it is noted to be missing.…”

Feasibility of the Cut‐and‐Push Method for Removing Large‐Caliber Soft Percutaneous Endoscopic Gastrostomy Devices

“…Although 5 remnants were not collected from feces, no cases of intestinal obstruction were noted (abdominal pain, absolute constipation, abdominal tenderness, nausea, or vomiting) during the study. Some alarming cases reported obstruction or perforation due to the inner flange embedded within the intestinal wall several months after the procedure 8 – 12 . Therefore, we recognize that a follow‐up period of 1 month might underestimate the real hazards of the cut‐and‐push technique.…”

“…So far, few studies have been conducted demonstrating the safety of the cut‐and‐push method of PEG removal up to 15 French (Fr) caliber 5 – 7 . However, concerns with this method arose from reports of severe complications 8 – 12 . Many queries with the technique are pending, and well‐established indications and limits are far from being defined.…”

Removal of percutaneous endoscopic gastrostomy tubes in adults using the “cut and push” method: A systematic review

“…There were 21 records that reported complications post CP in 24 patients with a wide range of age and diagnosis (see Table One). Of these 15 were elective CP ( 12,13,20,21,(27)(28)(29)(30)(31)(32)(33)(34)(35) ); three were CP following failed traction removal of the PEG ( 11 22, 23 ); two were elective CP due to the inability to perform a gastroscopy secondary to oesophageal stricture ( 10,24 ).…”