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Buried bumper syndrome: low incidence and safe endoscopic management.
Acta Gastroenterol Belg. 2011 Jun; 74(2):312-6.AG

Abstract

AIMS

Buried bumper syndrome (BBS) is a rare long-term complication of percutaneous endoscopic gastrostomy (PEG) and consists of a progressive impaction of the inner bumper of the tube in the mucosa of gastric wall. The aim of our study was to report our own experience with BBS, focusing on its incidence and endoscopic management.

PATIENTS AND METHODS

Medical records of a large group of 879 patients having undergone PEG insertion (2002-2009) were retrospectively reviewed. All PEG's were followed by our special Nutrition Support Team. Patients presenting with BBS during their follow-up were included in the study.

RESULTS

Only eight patients (8/879; 0.9%) developed BBS, which was confirmed during gastroscopy. Median time between PEG insertion and BBS diagnosis was 22.0+/-22.28 months. Five patients underwent successful treatment with: 1) flexible guide wire insertion through the internal orifice of the PEG to define its anatomical settings, 2) cruciform incisions of the gastric mucosa with a needle-knife starting at the center of the mucosal dome covering the internal bumper, and reaching its edges, 3) extrusion and complete extraction of the inner bumper through the gastric tract. No complications were observed. Median hospital stay related to BBS lasted 4.0+/-3.67 days. In two patients with peristomal abscess and deeply migrated bumper surgery was needed.

CONCLUSIONS

Cruciform mucosal incisions with needle-knife is a safe endoscopic technique to treat the BBS that could avoid surgery in most of the cases. Preventive measures applied after PEG insertion and continued during the follow-up may result in a distinctly lower prevalence of BBS.

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Authors+Show Affiliations

El AZ
Gastroenterology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Arvanitakis M
No affiliation info available
Ballarin A
No affiliation info available
Devière J
No affiliation info available
Le Moine O
No affiliation info available
Van Gossum A
No affiliation info available

MeSH

AdultAgedAged, 80 and overBelgiumDevice RemovalEndoscopy, GastrointestinalEnteral NutritionFemaleForeign BodiesGastrostomyHumansIncidenceIntubation, GastrointestinalMaleMiddle AgedRetrospective StudiesStomachSyndromeYoung Adult

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21861316

Citation

El, Ali Z., et al. "Buried Bumper Syndrome: Low Incidence and Safe Endoscopic Management." Acta Gastro-enterologica Belgica, vol. 74, no. 2, 2011, pp. 312-6.
El AZ, Arvanitakis M, Ballarin A, et al. Buried bumper syndrome: low incidence and safe endoscopic management. Acta Gastroenterol Belg. 2011;74(2):312-6.
El, A. Z., Arvanitakis, M., Ballarin, A., Devière, J., Le Moine, O., & Van Gossum, A. (2011). Buried bumper syndrome: low incidence and safe endoscopic management. Acta Gastro-enterologica Belgica, 74(2), 312-6.
El AZ, et al. Buried Bumper Syndrome: Low Incidence and Safe Endoscopic Management. Acta Gastroenterol Belg. 2011;74(2):312-6. PubMed PMID: 21861316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Buried bumper syndrome: low incidence and safe endoscopic management. AU - El,Ali Z, AU - Arvanitakis,M, AU - Ballarin,A, AU - Devière,J, AU - Le Moine,O, AU - Van Gossum,A, PY - 2011/8/25/entrez PY - 2011/8/25/pubmed PY - 2011/9/21/medline SP - 312 EP - 6 JF - Acta gastro-enterologica Belgica JO - Acta Gastroenterol Belg VL - 74 IS - 2 N2 - AIMS: Buried bumper syndrome (BBS) is a rare long-term complication of percutaneous endoscopic gastrostomy (PEG) and consists of a progressive impaction of the inner bumper of the tube in the mucosa of gastric wall. The aim of our study was to report our own experience with BBS, focusing on its incidence and endoscopic management. PATIENTS AND METHODS: Medical records of a large group of 879 patients having undergone PEG insertion (2002-2009) were retrospectively reviewed. All PEG's were followed by our special Nutrition Support Team. Patients presenting with BBS during their follow-up were included in the study. RESULTS: Only eight patients (8/879; 0.9%) developed BBS, which was confirmed during gastroscopy. Median time between PEG insertion and BBS diagnosis was 22.0+/-22.28 months. Five patients underwent successful treatment with: 1) flexible guide wire insertion through the internal orifice of the PEG to define its anatomical settings, 2) cruciform incisions of the gastric mucosa with a needle-knife starting at the center of the mucosal dome covering the internal bumper, and reaching its edges, 3) extrusion and complete extraction of the inner bumper through the gastric tract. No complications were observed. Median hospital stay related to BBS lasted 4.0+/-3.67 days. In two patients with peristomal abscess and deeply migrated bumper surgery was needed. CONCLUSIONS: Cruciform mucosal incisions with needle-knife is a safe endoscopic technique to treat the BBS that could avoid surgery in most of the cases. Preventive measures applied after PEG insertion and continued during the follow-up may result in a distinctly lower prevalence of BBS. SN - 1784-3227 UR - https://www.unboundmedicine.com/medline/citation/21861316/Buried_bumper_syndrome:_low_incidence_and_safe_endoscopic_management_ L2 - https://www.ageb.be/ageb-journal/ageb-volume/ageb-article/771 DB - PRIME DP - Unbound Medicine ER -