Endoscopic therapy of the buried bumper syndrome: a clinical algorithm

Abstract

In all cases inadequate gastrostomy care must be assumed as the reason for bumper overgrowth. Following ESPEN guidelines for PEG care may prevent BBS. BBS can routinely be diagnosed and treated by upper gastrointestinal endoscopy in a minimally invasive manner.

Observed high incidence of buried bumper syndrome associated with Freka PEG tubes

“…Factors which may contribute to development of BBS include the characteristics of the internal bumper, malnutrition, weight gain causing increase in abdominal wall thickness,1 and excessive external traction on the tube causing friction and ischaemic necrosis of the gastric submucosa 6. Adequate aftercare following PEG placement is also essential 5 7. Although BBS may occur within the first few months, it is generally regarded as a long-term complication, with case series reporting a median time from PEG insertion to development of BBS of 22–35 months 1 2 5…”

“…Adequate aftercare following PEG placement is also essential 5 7. Although BBS may occur within the first few months, it is generally regarded as a long-term complication, with case series reporting a median time from PEG insertion to development of BBS of 22–35 months 1 2 5…”

Buried bumper syndrome arising from a percutaneous endoscopic cecostomy tube

“…1,2 Moreover, sporadic cases of transesophageal drainage of PPs extending into the mediastinum have been also reported. [3][4][5][6] In contrast, in patients with altered anatomy because of previous gastric surgery, EUSguided transjejunal drainage has been described in only 1 patient with a Roux-en-Y anastomosis. 7 This probably reflects the concern for possible complications, making a percutaneous or surgical approach preferable.…”

Percutaneous Endoscopic Gastrostomy in Neurological Patients

“…Buried bumper syndrome often occurs months to years after PEG placement (median duration was 35 months after PEG placement) as the patient develops abdominal pain; difficulty feeding or flushing the tube; and the inability to advance, withdraw, or rotate the tube (Horbach et al, 2007). Buried www.intechopen.com bumper is thought to arise from excessive traction on the tube causing it to erode into the gastric wall.…”

“…The incidence of this complication has lessened with newer tube designs which utilize a softer internal bumper (Schapiro & Edmundowicz, 1996). Treatment involves removing the tube (which may require upper endoscopy), allowing the tract to close while an alternative method of feeding is established, and then placing a new PEG tube in a different location (Horbach et al, 2007). Fig.…”