Buried-bumper-Syndrom

Richter-Schrag, Hans-Jürgen; Fischer, Andreas

doi:10.1007/s00104-014-2973-x

Cited by 17 publications

(5 citation statements)

References 24 publications

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“…While the results revealed perfect diagnostic accuracy for conventional US and good potential for AI-based decision support, the results are potentially limited by the lack of endoscopic validation in BBS- cases. Therefore, especially early-stage BBS, classified as type II by Richter-Schrag 26 , could be missed. To further increase the diagnostic validity of US for the diagnosis of BBS, a standard procedure and documentation could be implemented as follows: mobilization of the PEG in its intragastral position during the examination and documentation of local findings including complications like abscesses of the abdominal wall and/or retention.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Buried Bumper Syndrome: Diagnostic Validity of Transabdominal Ultrasound and Artificial Intelligence

et al. 2021

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Purpose Buried bumper syndrome (BBS) is a severe complication of percutaneous endoscopic gastrostomy (PEG) resulting from overgrowth of gastric mucosa and penetration of the inner holding plate into the gastric wall. The aim of this study was to evaluate the diagnostic value of transabdominal ultrasound (US) in comparison to an artificial intelligence (AI) model for the diagnosis of BBS in children. Materials and Methods In this monocentric retrospective study, pediatric US data concerning BBS from a ten-year period (2009–2019) were analyzed. US findings were compared to a clinical multiparameter-based AI model and reference standard endoscopy. Clinical risk factors for the occurrence of pediatric BBS were determined. Results In n = 121 independent examinations of n = 82 patients, the placement of the inner holding plate of the PEG was assessed by US. In n = 18 cases BBS was confirmed. Recall and precision rates were 100 % for US and 88 % for the AI-based assessment. Risk factors for the occurrence of BBS were mobilization problems of the PEG (rs = 0.66, p < 0.001), secretion/exudation (rs = 0.29, p = 0.002), time between 1st PEG placement and US (rs = 0.38, p < 0.001), and elevated leukocyte count (rs = 0.24, p = 0.016). Conclusion Transabdominal US enables correct, rapid, and noninvasive diagnosis of BBS in pediatric patients. Preceding AI models could aid during diagnostic workup. To avoid unnecessary invasive procedures, US could be considered as a primary diagnostic procedure in suspected BBS.

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Section: Discussionmentioning

confidence: 99%

“…To date, endoscopy is used as the reference standard for the diagnostic and therapeutic workup in most cases of suspected BBS 10 11 26 . However, invasive endoscopic procedures are risky in children and multimorbid patients with PEG tubes 7 – especially when considering the need for sedation and its potential associated complications.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Buried Bumper Syndrome: Diagnostic Validity of Transabdominal Ultrasound and Artificial Intelligence

et al. 2021

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“…Richter-Schrag et al 22 recommended an endoscopic approach in stage II – IV, but stressed that conversion to the surgical method is often necessary in stage IV. Cyrany et al 23 based their classification on clinical, endoscopic and radiographic findings and specified 5 grades, and recommended surgical therapy from stage 4 onwards.…”

Section: Discussionmentioning

confidence: 99%

Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients

et al. 2017

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Background and study aims Buried bumper syndrome is an infrequent complication of percutaneous endoscopic gastrostomy (PEG) that can result in tube dysfunction, gastric perforation, bleeding, peritonitis or death. The aim of this study was to compare the efficacy of different PEG tube removal methods in the management of buried bumper syndrome in a large retrospective cohort. Patients and methods From 2002 to 2013, 82 cases of buried bumper syndrome were identified from the databases of two endoscopy referral centers. We evaluated the interval between gastrostomy tube placement and diagnosis of buried bumper syndrome, type of treatment, success rate and complications. Four methods were analyzed: bougie, grasp, needle-knife and minimally invasive push method using a papillotome, which were selected based on the depth of the buried bumper. Results The buried bumper was cut free with a wire-guided papillotome in 35 patients (42.7 %) and with a needle-knife in 22 patients (26.8 %). It could be pushed into the stomach with a dilator without cutting in 10 patients (12.2 %), and was pulled into the stomach with a grasper in 12 patients (14.6 %). No adverse events (AEs) were registered in 70 cases (85.4 %). Bleeding occurred in 7 patients (31.8 %) after cutting with a needle-knife papillotome and in 1 patient (8.3 %) after grasping. No bleeding was recorded after using a standard papillotome or a bougie ( P < 0.05). Ten of 22 patients (45.5 %) treated with the needle-knife had a serious AE and 1 patient died (4.5 %). Conclusions We recommend that incomplete buried bumpers be removed with a bougie. In cases of complete buried bumper syndrome, the bumper should be cut with a wire-guided papillotome and pushed into the stomach.

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“…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].…”

Section: Introductionmentioning

confidence: 93%

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

et al. 2016

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Percutaneous endoscopic gastrostomy (PEG) is thought to be a, relatively, safe procedure with a low rate of complications. Buried bumper syndrome (BBS) is the migration of the internal fixation device of PEG (bumper) out of the stomach and consists of a major and, usually, late complication with potentially lethal results. We present a case of such complication resulting in an extended anterior abdominal wall necrosis. An 87-year-old woman with a PEG placement 6 months before, due to Alzheimer's disease and inability of oral feeding, presented in a severe septic condition and with necrotic inflammation of the abdominal wall. Computerized tomography confirmed the migration of internal bumper subcutaneously. Excision of the gastrostomy and surgical debridement was performed, but, due to the patient's deteriorated condition, she died after 24 hours. PEG is ideal for patients with swallowing deficiencies, but severe complications may occur. Prevention and initiate diagnosis of the BBS are important for an early treatment, in order to avoid such severe complications.

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Buried-bumper-Syndrom

Cited by 17 publications

References 24 publications

Pediatric Buried Bumper Syndrome: Diagnostic Validity of Transabdominal Ultrasound and Artificial Intelligence

Pediatric Buried Bumper Syndrome: Diagnostic Validity of Transabdominal Ultrasound and Artificial Intelligence

Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients

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

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