|
1
|
Steinbrück I, Pohl J, Friesicke M, Grothaus J, von Hahn T, Drews J, Faiss S, Kuellmer A, Otto H, Allgaier HP. Treatment of the Buried Bumper Syndrome: A Retrospective Multicenter Study With Inclusion of 160 Cases. J Clin Gastroenterol 2025; 59:335-343. [PMID: 39008571 PMCID: PMC11882173 DOI: 10.1097/mcg.0000000000002018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/31/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND AND GOALS The therapy of buried bumper syndrome (BBS) is difficult. The aim of this retrospective multicenter study was to analyze the treatment methods with focus on effectiveness and safety of endoscopic techniques. METHODS The analysis of all therapies and a comparison of the papillotome technique (PT) and needle knife-based nonpapillotome technique (NPT) were performed. Primary endpoint was technical success in one session, secondary endpoints overall technical success, number and duration of treatment sessions, SAE, and mortality. RESULTS The primary treatment of 160 BBS cases, diagnosed between 2003 and 2021, was NPT in 60 (37.5%), PT in 43 (26.9%), push/pull technique (PPT) in 40 (25.0%), no removal in 9 (5.6%), laparotomy in 7 (4.4%) cases, and external incision in 1 (0.6%) case. For PT and NPT rates of technical success in one session were 95.5% and 45.0% ( P <0.01), rates of overall technical success 100% and 88.3% ( P =0.02), and mean number and duration of treatment sessions 1.05 (±0.21) versus 1.70 (±0.91) ( P <0.01) and 32.17 (±21.73) versus 98,00 (±62.28) minutes ( P <0.01), respectively. No significant differences between PT and NPT were found for SAE (15.9% vs. 25.0%) and mortality (2.3% vs. 1.7%). For PPT, laparotomy and external incision rates of technical success in one session and overall technical success were 100%, rates of SAE 2.5%, 50.0%, and 0% and mortality 0%, 10.0%, and 0%. CONCLUSIONS Endoscopic therapy of BBS is treatment of choice in most cases with removal of incomplete BB by PPT. In case of complete BB PT appears more effective than NPT.
Collapse
Affiliation(s)
- Ingo Steinbrück
- Department of Medicine and Gastroenterology, Protestant Deaconess Hospital (Evangelisches Diakoniekrankenhaus) Freiburg, Academic Teaching Hospital, University of Freiburg
| | - Jürgen Pohl
- Department of Gastroenterology, Asklepios Clinic Altona, Academic Teaching Hospital University of Hamburg, Hamburg
| | - Matthias Friesicke
- Department of Gastroenterology, Asklepios Clinic Altona, Academic Teaching Hospital University of Hamburg, Hamburg
| | - Johannes Grothaus
- Department of Gastroenterology, Asklepios Clinic Altona, Academic Teaching Hospital University of Hamburg, Hamburg
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology, and Endoscopy, Asklepios Clinic Barmbek, Academic Teaching Hospital University of Hamburg, Hamburg
| | - Jan Drews
- Department of Gastroenterology, Hepatology, and Endoscopy, Asklepios Clinic Barmbek, Academic Teaching Hospital University of Hamburg, Hamburg
| | - Siegbert Faiss
- Department of Gastroenterology, Sana Hospital Lichtenberg, Academic Teaching Hospital, University of Berlin, Berlin, Germany
| | - Armin Kuellmer
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Helge Otto
- Department of Gastroenterology, Asklepios Clinic Altona, Academic Teaching Hospital University of Hamburg, Hamburg
| | - Hans-Peter Allgaier
- Department of Medicine and Gastroenterology, Protestant Deaconess Hospital (Evangelisches Diakoniekrankenhaus) Freiburg, Academic Teaching Hospital, University of Freiburg
| |
Collapse
|
|
2
|
Orlandoni P, Jukic Peladic N. Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity. Nutrients 2024; 16:2893. [PMID: 39275209 PMCID: PMC11397536 DOI: 10.3390/nu16172893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/16/2024] Open
Abstract
INTRODUCTION The main risk factors for major complications and early mortality after the positioning of percutaneous endoscopic gastrostomy (PEG) reported in the literature are old age, multimorbidity, and the use of inappropriate methods for PEG positioning. A proper PEG positioning technique and adequate post-positioning patient management and surveillance are the main protective factors, but the information on protective factors in the literature is much poorer. The aim of this study was to provide more information on PEG-related complications and mortality in geriatric patients treated with long-term enteral nutrition administered by PEG according to a specific home enteral nutrition (HEN) protocol. METHODS This was a retrospective study based on data from 136 elderly patients in whom PEG was positioned from 2017 to 2023 at the geriatric hospital IRCCS INRCA, Ancona (Italy), 88 of whom were treated with HEN. Data on PEG-related complications, duration of HEN, hospitalizations, and mortality were analyzed. RESULTS No complications were registered during or immediately after the PEG positioning. The prevalence of a major complication-buried bumper-was in the lower limit of the range reported in the literature (4.32%). The prevalence of minor complications such as peristomal leakage, inadvertent tube removal, and granulation tissue was higher than that reported in the literature (14.71%, 23.53%, 29.41%), while tube blockage and peristomal site infection were less frequent (8.82%, 38.23%). Three hospitalizations for PEG-related complications occurred. Both the all-cause 30-day mortality and within-two-months mortality were lower than those in the literature (1.92% and 3.84%). CONCLUSIONS The impact of the risk factors recognized by the literature on complications and mortality could be probably mitigated by improving the PEG placement techniques and pre- and post-PEG placement patient management practices. Data on the prevalence of complications and mortality must be interpreted in correlation to this information.
Collapse
Affiliation(s)
- Paolo Orlandoni
- Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
| | - Nikolina Jukic Peladic
- Vivisol Srl. at Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
| |
Collapse
|
|
3
|
Bronswijk M, Christiaens P. A novel device for buried bumper syndrome management: not all roses and sunshine. Gastrointest Endosc 2024; 99:474. [PMID: 38368046 DOI: 10.1016/j.gie.2023.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden; Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven; Imelda Clinical GI Research Center, Bonheiden
| | - Paul Christiaens
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| |
Collapse
|
|
4
|
Wannhoff A, Küllmer A, Albers D, Fähndrich M, Ganten T, Wettstein M, Meier B, Schumacher B, Schmidt A, Caca K. Prospective randomized controlled trial comparing a novel and dedicated device with conventional endoscopic techniques for the treatment of buried bumper syndrome (with video). Gastrointest Endosc 2024; 99:23-30.e1. [PMID: 37543062 DOI: 10.1016/j.gie.2023.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/27/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AND AIMS Buried bumper syndrome (BBS) is a rare adverse event of PEG tubes. This study compared the newly developed Flamingo device (Fujifilm Medwork GmbH, Höchstadt, Germany) with conventional endoscopic techniques for BBS treatment. METHODS This prospective, randomized controlled trial compared the Flamingo set (study group) with other endoscopic techniques (control group) for BBS treatment in 6 German hospitals. The primary endpoint was procedure time. Further outcome parameters were technical success, adverse event rate, and number and cost of devices used in each group. RESULTS Thirty-six patients (18 in each group; mean age, 73 years; 12 women) were included in this study between March 2018 and December 2022. Median time since placement of the feeding tube was 30 months. The bumper was located in the gastric corpus in 27 patients, and the internal bumper was completely overgrown in 31 patients. The duration of the removal procedure was 17 minutes (range, 3-72) in the study group compared with 38 minutes (range, 12-111) in the control group (P = .046). The primary technical success rate was 77.8% in the study group and 55.6% in the control group (P = .157), whereas the overall technical success rate was 100% compared with 83.3% (P = .070). Adverse events occurred in 4 patients (11.1%). CONCLUSIONS Endoscopic removal of the buried bumper using the Flamingo device was significantly faster than that with other endoscopic techniques and showed a higher technical success rate. This device may become the endoscopic treatment of choice for BBS. (Clinical trial registration number: NCT03186066.).
Collapse
Affiliation(s)
- Andreas Wannhoff
- Department of Internal Medicine and Gastroenterology, Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Armin Küllmer
- Department of Medicine II, Medical Center-University of Freiburg, Freiburg, Germany
| | - David Albers
- Department of Gastroenterology, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Martin Fähndrich
- Department of Internal Medicine and Gastroenterology, Hospital Dortmund, Dortmund, Germany
| | - Tom Ganten
- Internal Medicine I and Gastroenterology, Fürst-Stirum Hospital Bruchsal, Bruchsal, Germany
| | | | - Benjamin Meier
- Department of Internal Medicine and Gastroenterology, Hospital Ludwigsburg, Ludwigsburg, Germany
| | | | - Arthur Schmidt
- Department of Medicine II, Medical Center-University of Freiburg, Freiburg, Germany
| | - Karel Caca
- Department of Internal Medicine and Gastroenterology, Hospital Ludwigsburg, Ludwigsburg, Germany
| |
Collapse
|
|
5
|
Mondorf A, Amini C, Graf C, Michael FA, Blumenstein I, Jung M, Friedrich-Rust M, Hack D, Besier SM, Hogardt M, Kempf VAJ, Zeuzem S, Welsch C, Bojunga J. Risk Factors and Role of Antibiotic Prophylaxis for Wound Infections after Percutaneous Endoscopic Gastrostomy. J Clin Med 2023; 12:jcm12093175. [PMID: 37176616 PMCID: PMC10179185 DOI: 10.3390/jcm12093175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND AND STUDY AIM The incidence of wound infections after percutaneous endoscopic gastrostomy (PEG) varies widely in recent studies. The present study systematically investigates the underlying risk factors for the development of wound infections in a large cohort of patients over a long-term follow-up period. PATIENTS AND METHODS A retrospective cohort study of patients undergoing PEG insertion using either the pull or push technique was conducted and patients followed up for 3 years. Tube-related wound infections were identified, and pathogens regularly cultured from wound swabs. Adjusted analysis was performed via univariate and multivariate logistic regression analysis. RESULTS 616 patients were included in this study. A total of 25% percent of patients developed wound infections upon PEG tube insertion and 6.5% showed recurrent infections. Nicotine abuse (p = 0.01), previous ischemic stroke (p = 0.01) and head and neck cancer (p < 0.001) showed an increased risk for wound infection after PEG placement. Moreover, radio-chemotherapy was associated with the occurrence of wound infections (p < 0.001). Infection rates were similar between pull and push cohorts. The most common bacterial pathogen detected was Enterobacterales (19.2%). Staphylococcus aureus, Pseudomonas aeruginosa and enterococci were frequently detected in recurrent infection (14.2%, 11.4% and 9.6%, respectively). Antibiotic prophylaxis showed no effect on infection rates. CONCLUSIONS Wound infections after PEG placement are common and occasionally occur as recurrent infections. There is potential for improvement in everyday clinical practice, particularly regarding antibiotic prophylaxis in accordance with guidelines.
Collapse
Affiliation(s)
- Antonia Mondorf
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Clara Amini
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Christiana Graf
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Florian Alexander Michael
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Irina Blumenstein
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Michael Jung
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Daniel Hack
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, 60596 Frankfurt am Main, Germany
| | - Silke M Besier
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, 60596 Frankfurt am Main, Germany
| | - Michael Hogardt
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, 60596 Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, 60596 Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Christoph Welsch
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| |
Collapse
|
|
6
|
Gautam M, Sharma A. An Incidental Discovery of a Serious Complication. Gastroenterology 2023; 164:e10-e12. [PMID: 36155187 DOI: 10.1053/j.gastro.2022.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022]
Affiliation(s)
- M Gautam
- Mayo Clinic, Rochester, Minnesota
| | - A Sharma
- Medical College of Georgia, Augusta, Georgia.
| |
Collapse
|
|
7
|
Bouchiba H, Jacobs MAJM, Bouma G, Ramsoekh D. Outcomes of push and pull percutaneous endoscopic gastrostomy placements in 854 patients: A single‐center study. JGH Open 2021; 6:57-62. [PMID: 35071789 PMCID: PMC8762618 DOI: 10.1002/jgh3.12694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Hicham Bouchiba
- Department of Gastroenterology and Hepatology Amsterdam University Medical Center, Location VUmc Amsterdam The Netherlands
| | - Maarten A J M Jacobs
- Department of Gastroenterology and Hepatology Amsterdam University Medical Center, Location VUmc Amsterdam The Netherlands
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology Amsterdam University Medical Center, Location VUmc Amsterdam The Netherlands
| | - Dewkoemar Ramsoekh
- Department of Gastroenterology and Hepatology Amsterdam University Medical Center, Location VUmc Amsterdam The Netherlands
| |
Collapse
|
|
8
|
Perkutane endoskopische Gastrostomie bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
|
9
|
Lascano D, Kelley-Quon LI. Management of Postoperative Complications Following Common Pediatric Operations. Surg Clin North Am 2021; 101:799-812. [PMID: 34537144 DOI: 10.1016/j.suc.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review discusses complications unique to pediatric surgical populations. Here the authors focus primarily on five of the most common procedures performed in children: appendectomy, central venous catheterization, pyloromyotomy, gastrostomy, and inguinal/umbilical hernia repair.
Collapse
Affiliation(s)
- Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #100, Los Angeles, CA 90027, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #100, Los Angeles, CA 90027, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
|
10
|
Ölmez Ş, Sarıtaş B, Yalçın MS, Öztürk NA, Taş A, Kara B. Buried Bumper Syndrome: Early or Late? Gastroenterol Nurs 2021; 44:328-333. [PMID: 34319936 DOI: 10.1097/sga.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022] Open
Abstract
Buried bumper syndrome (BBS) is a rare and serious complication of percutaneous endoscopic gastrostomy (PEG) tube placement. In the literature, BBS is considered to be a late complication of PEG procedure, but it may occur in the early period after PEG tube placement. Early diagnosis and proper treatment are important. Different treatment modalities may be used to treat BBS. The aim of this study was to evaluate patients with BBS. During a time frame between January 2015 and February 2020, a hospital medical database was screened for PEG placement and BBS. Buried bumper syndrome was found in 36 patients. Demographic and clinical characteristics of these patients were retrospectively investigated. Those who developed BBS in the first month were evaluated as early BBS. Those who developed BBS after more than a month were evaluated as late BBS. The median BBS development time was 135.9 ± 208.1 days (9-834 days). In 18 (50%) patients, BBS developed within the first month. Serious complications such as abscess and peritonitis were observed in 8 (22.2%) patients on admission. Thirty-two (88.9%) of 36 patients were treated with external traction and four patients were treated with surgery. No complications were observed in patients who were treated with traction. Five patients died, of whom three of them died because of BBS complications, whereas two of them died from other causes unrelated to BBS. Buried bumper syndrome is a complication that can be seen in the early period after gastrostomy. External traction is a reliable method for treating these patients. Proper education of patients' relatives and caregivers is very important to prevent BBS and related complications.
Collapse
Affiliation(s)
- Şehmus Ölmez
- Şehmus Ölmez, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Bünyamin Sarıtaş, MD, is Specialist, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Mehmet Suat Yalçın, MD, is Associate Professor, Department of Gastroenterology, Aksaray University, Aksaray, Turkey
- Nevin Akçaer Öztürk, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Adnan Taş, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Banu Kara, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
| | - Bünyamin Sarıtaş
- Şehmus Ölmez, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Bünyamin Sarıtaş, MD, is Specialist, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Mehmet Suat Yalçın, MD, is Associate Professor, Department of Gastroenterology, Aksaray University, Aksaray, Turkey
- Nevin Akçaer Öztürk, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Adnan Taş, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Banu Kara, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
| | - Mehmet Suat Yalçın
- Şehmus Ölmez, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Bünyamin Sarıtaş, MD, is Specialist, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Mehmet Suat Yalçın, MD, is Associate Professor, Department of Gastroenterology, Aksaray University, Aksaray, Turkey
- Nevin Akçaer Öztürk, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Adnan Taş, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Banu Kara, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
| | - Nevin Akçaer Öztürk
- Şehmus Ölmez, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Bünyamin Sarıtaş, MD, is Specialist, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Mehmet Suat Yalçın, MD, is Associate Professor, Department of Gastroenterology, Aksaray University, Aksaray, Turkey
- Nevin Akçaer Öztürk, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Adnan Taş, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Banu Kara, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
| | - Adnan Taş
- Şehmus Ölmez, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Bünyamin Sarıtaş, MD, is Specialist, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Mehmet Suat Yalçın, MD, is Associate Professor, Department of Gastroenterology, Aksaray University, Aksaray, Turkey
- Nevin Akçaer Öztürk, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Adnan Taş, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Banu Kara, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
| | - Banu Kara
- Şehmus Ölmez, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Bünyamin Sarıtaş, MD, is Specialist, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Mehmet Suat Yalçın, MD, is Associate Professor, Department of Gastroenterology, Aksaray University, Aksaray, Turkey
- Nevin Akçaer Öztürk, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Adnan Taş, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
- Banu Kara, MD, is Associate Professor, Department of Gastroenterology, Health Sciences University, Adana City Training & Research Hospital, Adana, Turkey
| |
Collapse
|
|
11
|
Dhannoon A, AlKhattab M, Sehgal R, Collins CG. Buried bumper syndrome: a case report of an early PEG gastropexy-associated complication in a patient with gastric volvulus. J Surg Case Rep 2021; 2021:rjab261. [PMID: 34234941 PMCID: PMC8257257 DOI: 10.1093/jscr/rjab261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022] Open
Abstract
Buried bumper syndrome (BBS) is a rare complication associated with percutaneous endoscopic gastrostomy (PEG) tubes. It develops when the internal bumper migrates through the gastric wall, lodging anywhere along the gastrostomy tract leading to overgrowth of gastric mucosa thereby encasing the tube. BBS can lead to bleeding, perforation, peritonitis and intra-abdominal sepsis. Our case is a 71-year-old female presenting with tenderness, erythema and purulent discharge at the PEG tube site 2-weeks post-insertion. Computer tomography scan demonstrated the PEG had dislodged with the internal bumper in the subcutaneous tissue and the distal tip lying within the tract beyond the stomach wall. The PEG was removed by simple external traction. The patient clinically improved and discharged home on day three. Although BBS usually occurs late post-PEG insertion, it can also occur acutely. Preventative measures should be adopted at ward-level and emphasized with appropriate PEG tube care information provided to patients to avoid and recognize such complication.
Collapse
Affiliation(s)
- Amenah Dhannoon
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Maha AlKhattab
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Rishabh Sehgal
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Chris G Collins
- Department of Surgery, University Hospital Galway, Galway, Ireland
| |
Collapse
|
|
12
|
Costa D, Despott EJ, Lazaridis N, Woodward J, Kohout P, Rath T, Scovell L, Gee I, Hindryckx P, Forrest E, Hollywood C, Hearing S, Mohammed I, Coppo C, Koukias N, Cooney R, Sharma H, Zeino Z, Gooding I, Murino A. Multicenter cohort study of patients with buried bumper syndrome treated endoscopically with a novel, dedicated device. Gastrointest Endosc 2021; 93:1325-1332. [PMID: 33221321 DOI: 10.1016/j.gie.2020.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Buried bumper syndrome (BBS) is a rare adverse event of percutaneous endoscopic gastrostomy (PEG) placement in which the internal bumper migrates through the stomal tract to become embedded within the gastric wall. Excessive tension between the internal and external bumpers, causing ischemic necrosis of the gastric wall, is believed to be the main etiologic factor. Several techniques for endoscopic management of BBS have been described using off-label devices. The Flamingo set is a novel, sphincterotome-like device specifically designed for BBS management. We aimed to evaluate the effectiveness of the Flamingo device in a large, homogeneous cohort of patients with BBS. METHODS A guidewire was inserted through the external access of the PEG tube into the gastric lumen. The Flamingo device was then introduced into the stomach over the guidewire. This dedicated tool can be flexed by 180 degrees, exposing a sphincterotome-like cutting wire, which is used to incise the overgrown tissue until the PEG bumper is exposed. A retrospective, international, multicenter cohort study was conducted on 54 patients between December 2016 and February 2019. RESULTS The buried bumper was successfully removed in 53 of 55 procedures (96.4%). The median time for the endoscopic removal of the buried bumper was 22 minutes (range, 5-60). Periprocedural endoscopic adverse events occurred in 7 procedures (12.7%) and were successfully managed endoscopically. A median follow-up of 150 days (range, 33-593) was performed in 29 patients (52.7%), during which no significant adverse events occurred. CONCLUSIONS Through our experience, we found this dedicated novel device to be safe, quick, and effective for minimally invasive, endoscopic management of BBS.
Collapse
Affiliation(s)
- Deborah Costa
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Jeremy Woodward
- Department of Gastroenterology and Clinical Nutrition Addenbrooke's Hospital, Cambridge, UK
| | - Pavel Kohout
- Department of Internal Medicine Thomayer Hospital, Prague, Czech Republic
| | - Timo Rath
- Division of Gastroenterology, Department of Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Louise Scovell
- Gastrointestinal and Liver services Ipswich Hospital, Ipswich, UK
| | - Ian Gee
- Department of Gastroenterology, Worcestershire Acute Hospital, Worcester, UK
| | - Pieter Hindryckx
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - Ewan Forrest
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Coral Hollywood
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Stephen Hearing
- Department of Gastroenterology and Hepatology, University Hospitals of Derby and Burton, Derby, UK
| | - Imtiyaz Mohammed
- Department of Gastroenterology Sandwell and West Birmingham Hospitals, Lyndon, West Bromwich, West Midlands, UK
| | - Claudia Coppo
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK
| | - Hemant Sharma
- Gastrointestinal and Liver Services, Maidstone and Tunbridge Wells Hospital, Maidstone and Pembury, UK
| | - Zeino Zeino
- Department of Gastroenterology and Hepatology, North Bristol Trust, Bristol, UK
| | - Ian Gooding
- Department of Gastroenterology, Colchester General Hospital, Colchester, UK
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| |
Collapse
|
|
13
|
Spanaki C, Boura I, Avgoustaki A, Orfanoudaki E, Giannopoulou IA, Giakoumakis E, Chlouverakis G, Athanasakis E, Koulentaki M. Buried Bumper Syndrome: A common complication of levodopa intestinal infusion for Parkinson disease. Parkinsonism Relat Disord 2021; 85:59-62. [PMID: 33743506 DOI: 10.1016/j.parkreldis.2021.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is required for Levodopa/Carbidopa Intestinal Gel (LCIG) delivery in patients with advanced Parkinson's disease (PD) as well as for enteral feeding in a variety of neurological disorders. Buried Bumper Syndrome (BBS) is a serious complication of PEG. The frequency of BBS in patients receiving LCIG treatment has never been reported. OBJECTIVES To compare the frequency of BBS in patients on LCIG treatment or on enteral feeding over the past 12 years and identify possible risk factors. METHODS We reviewed prospectively recorded data from 2009 to 2020 on two case-series: LCIG-treated PD patients and non-PD patients on enteral nutrition. We identified all BBS incidences. Patients' characteristics, clinical manifestations, BBS management, possible risk factors and outcomes were analyzed. RESULTS During the 12 years, 35 PD patients underwent PEG insertion for LCIG infusion, and 123 non-PD patients for nutritional support. There were eight cases of BBS in six PD patients (17.1%). Six of them were effectively managed without treatment discontinuation. Of the enteral feeding patients, only one developed BBS (0.8%) (p < 0.001). We identified inappropriate PEG site aftercare, weight gain, early onset PD, longer survival, treatment duration, dementia and PEG system design as potential risk factors for BBS development. CONCLUSIONS BBS occurs more frequently in LCIG patients than in patients receiving enteral feeding. If detected early, it can be successfully managed, and serious sequalae or treatment discontinuation can be avoided. Regular endoscopic follow-up visits of LCIG-treated patients and increased awareness in patients and clinicians are recommended.
Collapse
Affiliation(s)
- Cleanthe Spanaki
- Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; University of Crete, School of Medicine, Voutes University Campus, Heraklion, 70013, Crete, Greece.
| | - Iro Boura
- Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; University of Crete, School of Medicine, Voutes University Campus, Heraklion, 70013, Crete, Greece
| | - Aikaterini Avgoustaki
- Department of Gastroenterology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| | - Eleni Orfanoudaki
- Department of Gastroenterology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; Department of Gastroenterology, General Hospital of Chania, Mournies, 73300, Chania, Crete, Greece
| | - Irene Areti Giannopoulou
- Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; University of Crete, School of Medicine, Voutes University Campus, Heraklion, 70013, Crete, Greece
| | - Emmanouil Giakoumakis
- Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| | - Gregory Chlouverakis
- Department of Social Medicine, Biostatistics Lab, School of Medicine, University of Crete, Voutes Place, 71500, Heraklion, Crete, Greece
| | - Elias Athanasakis
- Department of General Surgery, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| | - Mairi Koulentaki
- Department of Gastroenterology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| |
Collapse
|
|
14
|
Ali S, Tahan V, Abdel Jalil A. Early Buried Bumper Syndrome: A Rare Complication of Percutaneous Endoscopic Gastrostomy Tube Placement. Cureus 2020; 12:e9177. [PMID: 32802612 PMCID: PMC7425833 DOI: 10.7759/cureus.9177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/14/2020] [Indexed: 11/08/2022] Open
Abstract
Early buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG) tube placement where the internal bolster gets "buried" in the gastrocutaneous fistulous tract. BBS is usually a late complication with onset > four weeks of PEG placement. We present a case of early BBS presenting at day 17 after PEG tube placement where the internal bolster got embedded in the subcutaneous fat just outside the gastric wall. The patient underwent urgent endoscopic removal of the buried bumper with the simple external traction, followed by the successful placement of a new tube through the same tract. Early diagnosis and prompt management are of paramount importance to avoid an ominous outcome.
Collapse
Affiliation(s)
- Saeed Ali
- Internal Medicine, University of Iowa, Iowa City, USA
| | - Veysel Tahan
- Gastroenterology, University of Missouri Columbia, Columbia, USA
| | - Ala Abdel Jalil
- Gastroenterology and Hepatology, Creighton University, Omaha, USA
| |
Collapse
|
|
15
|
Frischmeyer-Guerrerio PA, MacCarrick G, Dietz HC, Stewart FD, Guerrerio AL. Safety and outcome of gastrostomy tube placement in patients with Loeys-Dietz syndrome. BMC Gastroenterol 2020; 20:71. [PMID: 32164578 PMCID: PMC7066767 DOI: 10.1186/s12876-020-01213-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Loeys-Dietz syndrome (LDS) is a systemic connective tissue disease (CTD) associated with a predisposition for intestinal inflammation, food allergy, and failure to thrive, often necessitating nutritional supplementation via gastrostomy tube. Poor wound healing has also been observed in in some patients with CTD, potentially increasing the risk of surgical interventions. We undertook to determine the safety and efficacy of gastrostomy tube placement in this population. Methods We performed a retrospective cohort study of 10 LDS patients who had a total of 12 gastrostomy tubes placed. Results No procedural complications occurred, although one patient developed buried bumper syndrome in the near post-procedural time period and one patient had a small abscess at a surgical stitch. Most patients exhibited improvements in growth, with a median immediate improvement in BMI Z-score of 0.2 per month following the institution of gastrostomy tube feedings. Those with uncontrolled inflammation due to inflammatory bowel disease or eosinophilic gastrointestinal disease showed the least benefit and in some cases failed to demonstrate significant weight gain despite nutritional supplementation. Conclusions Gastrostomy tube placement (surgical or endoscopic) is a generally safe and a reasonable therapeutic option for patients with LDS despite their underlying CTD.
Collapse
Affiliation(s)
| | - Gretchen MacCarrick
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harry C Dietz
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Howard Hughes Institute, Chevy Chase, MD, USA
| | - F Dylan Stewart
- Department of Surgery, Westchester Medical Center, Section of Pediatric Surgery, Maria Fareri Children's Hospital, Valhalla, NY, USA
| | - Anthony L Guerrerio
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, CMSC 2-116, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| |
Collapse
|
|
16
|
Nakamura H, Kikuchi S, Ohnuma H, Hirakawa M, Kato J. Total buried bumper syndrome: A case study in transabdominal removal using a technique of endoscopic submucosal dissection. Clin Case Rep 2019; 7:2012-2013. [PMID: 31624631 PMCID: PMC6787815 DOI: 10.1002/ccr3.2409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/25/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
Tube removal by endoscopic submucosal dissection using needle and insulation-tipped diathermic knives against buried bumper syndrome is a reliable, noninvasive and safe procedure.
Collapse
Affiliation(s)
- Hajime Nakamura
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Shohei Kikuchi
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Hiroyuki Ohnuma
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Masahiro Hirakawa
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Junji Kato
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| |
Collapse
|
|
17
|
Devia J, Santivañez JJ, Rodríguez M, Rojas S, Cadena M, Vergara A. Early Recognition and Diagnosis of Buried Bumper Syndrome: A Report of Three Cases. Surg J (N Y) 2019; 5:e76-e81. [PMID: 31448333 PMCID: PMC6706275 DOI: 10.1055/s-0039-1692148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/25/2019] [Indexed: 02/06/2023] Open
Abstract
Buried bumper syndrome (BBS) was described as a complication of percutaneous endoscopic gastrostomy (PEG) that occurs when the internal stump of the probe migrates and is located between the gastric wall and the skin. The increase of compression between the internal stump and the external stump of the gastrostomy tube causes pain and the inability to feed. We present the cases of three patients with BBS managed by the metabolic and nutritional support department. These cases intend to illustrate one of the less frequent complications of PEG, clinical presentation, risk factors, diagnosis, and especially clinical management. Although there are no defined gold standards for its management, the most important points in the management of this condition are early recognition, recommendations to avoid ischemic process at the moment of the insertion of the tube, specific care of the gastrostomy tube, and a periodic nutrition evaluation to avoid overweight, which causes traction and excessive pressure in the gastric wall. It is important for physicians to be aware of the recommendations to prevent BBS and its complications, especially in patients in whom communication can be difficult secondary to their pathologies and comorbidities.
Collapse
Affiliation(s)
- Johan Devia
- Fundación Santa Fe de Bogotá, Intensive Care Unit, Universidad del Rosario, Bogotá, Colombia
| | - Juan Jose Santivañez
- Fundación Santa Fe de Bogotá, General Surgery, Universidad del Rosario, Bogotá, Colombia
| | | | - Sandra Rojas
- Fundación Santa Fe de Bogotá, General Surgery, Universidad Surcolombiana, Bogotá, Colombia
| | - Manuel Cadena
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Arturo Vergara
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| |
Collapse
|
|
18
|
ACUTE BURIED BUMPER SYNDROME: A RARE ENTITY. Gastroenterol Nurs 2019; 42:388-390. [PMID: 31365427 DOI: 10.1097/sga.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
|
19
|
Johnson TW, RN SS, Epp L, Mundi MS. Addressing Frequent Issues of Home Enteral Nutrition Patients. Nutr Clin Pract 2019; 34:186-195. [PMID: 30741496 DOI: 10.1002/ncp.10257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Teresa W. Johnson
- Department of Kinesiology & Health Promotion; Troy University; Troy AL USA
| | | | - Lisa Epp
- Mayo Clinic; Rochester Minnesota USA
| | | |
Collapse
|
|
20
|
Abstract
AIM Buried Bumper (BB) is a complication of percutaneous endoscopic gastrostomy (PEG) that leads to tube dysfunction and major morbidity. Although many techniques have been described to manage BB, none are universally adopted, and laparotomy remains the mainstay. We introduce a novel endoscopic technique in paediatric surgery that avoids laparotomy. METHODS A retrospective review of medical records of patients who presented with BB to Cambridge University Hospital, UK, between January 2012 and June 2018 was done. Data collected included: demographics, tube size and type, interval between insertion and diagnosis of BB, hospital stay, technique used, and postoperative complications. The technique involved using an endoscopic snare passed from inside the stomach lumen through the PEG lumen to the outside, guided if required by a stiff nylon thread if no part of the PEG was visible, grasping the PEG tube externally after cutting it short, followed by a retrograde pull to remove the buried tube via the mouth. MAIN RESULTS Fifteen BBs were found in ten patients. Median patient age was 5.25 years (1.2-16.6). Median time between gastrostomy insertion and diagnosis of BB was 9 months (1-32). Twelve BBs were removed endoscopically with no postoperative complications. Patients had a replacement inserted through the original track and were discharged within 24 h. Two underwent laparotomies performed by surgeons unfamiliar with endoscopic technique, and one was converted to laparotomy owing to inability to transverse an encrusted and closed PEG tube lumen. CONCLUSION Endoscopic retrograde BB removal is a safe, easy, and quick technique with minimal complications. We strongly advocate widespread adoption of the technique before considering a laparotomy. LEVEL OF EVIDENCE Treatment study: Level IV.
Collapse
|
|
21
|
Abstract
A 29-year-old man presented to the Accident and Emergency department with abdominal cramping following ingestion of a 50 p coin 2½ weeks prior to presentation. He had not observed it pass in his stools. An abdominal radiograph confirmed the presence of the 50 p coin in his stomach. Subsequently, he had an oesophagogastroduodenoscopy (OGD) performed with a failure to visualise the coin. 1½ weeks later, he returned to the department as he was still unable to observe its passing in his stools. A repeated abdominal radiograph and a CT of the abdomen and pelvis revealed that the coin was still in his stomach. A second OGD was performed once again with a failure to visualise the coin. It appeared that the coin had migrated into his gastric mucosa.
Collapse
Affiliation(s)
- Dominic Ti Ming Tan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Yih Chyn Phan
- County Hospital Hereford, Hereford, United Kingdom.,College of Medicine and Veterinary Medicine, Edinburgh Medical School, The University of Edinburgh, Edinburgh, United Kingdom
| | - Edmund Leung
- County Hospital Hereford, Hereford, United Kingdom
| |
Collapse
|
|
22
|
Kulvatunyou N, Zimmerman SA, Sadoun M, Joseph BA, Friese RS, Gries LM, O'Keeffe T, Tang AL. Comparing Outcomes Between "Pull" Versus "Push" Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement. J Surg Res 2018; 232:56-62. [PMID: 30463774 DOI: 10.1016/j.jss.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 03/24/2018] [Accepted: 06/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) complications are often under-reported in the literature, especially regarding the incidence of tube dislodgement (TD). TD can cause significant morbidity depending on its timing. We compared outcomes between "push" and "pull" PEGs. We hypothesized that push PEGs, because of its T-fasteners and balloon tip, would have a lower incidence of TD and complications compared with pull PEGs. METHODS We performed a chart review of our prospectively maintained acute care surgery database for patients who underwent PEG tube placement from July 1, 2009 through June 30, 2013. Data regarding age, gender, body mass index, indications (trauma versus nontrauma), and complications (including TD) were extracted. Procedure-related complications were classified as either major if patients required an operative intervention or minor if they did not. We compared outcomes between pull PEG and push PEG. Multiple regression analysis was performed to identify risk factors associated with major complications. RESULTS During the 4-y study period, 264 patients underwent pull PEGs and 59 underwent push PEGs. Age, gender, body mass index, and indications were similar between the two groups. The overall complications (major and minor) were similar (20% pull versus 22% push, P = 0.61). The incidence of TD was also similar (12% pull versus 9% push, P = 0.49). However, TD associated with major complications was higher in pull PEGs but was not statistically significant (6% pull versus 2% push, P = 0.21). Multiple regression analysis showed that dislodged pull PEG was associated with major complications (odds ratio 29.5; 95% confidence interval, 11.3-76.9; P < 0.001). CONCLUSIONS The incidence of pull PEG TD associated with major complications is under-recognized. Specific measures should be undertaken to help prevent pull PEG TD. LEVEL OF EVIDENCE IV, therapeutic.
Collapse
Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Steven A Zimmerman
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona.
| | - Moutamn Sadoun
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bellal A Joseph
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Randall S Friese
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Lynn M Gries
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Terence O'Keeffe
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew L Tang
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| |
Collapse
|
|
23
|
Abstract
Buried Bumper Syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG) tubes. Advice in prevention guidelines differ, but locally agreed protocols can be agreed using the existing evidence. Consideration needs to be given as to how tightly a PEG is clipped after insertion to prevent gastric leakage, and how long after the procedure should it be loosened to prevent BBS. The distance a PEG tube is advanced and whether it should be rotated is also important in order to prevent BBS. The locally developed protocols need to include clear instructions for staff and patients and a supportive education programme, alongside clear record keeping.
Collapse
|
|
24
|
Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy (PEG/PEJ) in Adult Patients. J Wound Ostomy Continence Nurs 2018; 45:326-334. [DOI: 10.1097/won.0000000000000442] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
|
25
|
Strollo BP, McClave SA, Miller KR. Complications of Home Enteral Nutrition: Mechanical Complications and Access Issues in the Home Setting. Nutr Clin Pract 2017; 32:723-729. [PMID: 29927520 DOI: 10.1177/0884533617734529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025] Open
Abstract
Home enteral nutrition (HEN) is an essential component in the care of patients with an array of underlying etiologies resulting in the inability to meet caloric needs through volitional intake alone. Although some would include oral nutrition supplementation as HEN, for the purposes of this review, the term is limited to a patient's requiring an enteral access device for the delivery of exogenous nutrients. Complications related to such devices remain a difficult problem in the hospital setting, and these issues are often amplified when encountered in the home setting. Focused multidisciplinary teams and close follow-up are essential in optimizing outcomes for patients receiving HEN, but all healthcare providers should have foundational knowledge regarding commonly encountered complications of HEN access and the initial management of these issues.
Collapse
Affiliation(s)
- Brian P Strollo
- Department of Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Stephen A McClave
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Keith R Miller
- Department of Surgery, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
|
26
|
Chen HY, Chen CJ, Chen WC, Wang SJ, Chen YH. A promising protein responsible for overactive bladder in ovariectomized mice. Taiwan J Obstet Gynecol 2017; 56:196-203. [PMID: 28420508 DOI: 10.1016/j.tjog.2016.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Ovariectomy (OVX) in mice is a model mimicking a neuro-electronic proof of an overactive bladder in postmenopausal women. Overactive bladder (OAB) was recently found to be due to an altered gap junction protein in a rat model. Thus, this study was conducted to evaluate changes in cell junction protein expression and composition in the bladder of OVX mice. MATERIALS AND METHODS Thirty-six virgin female mice were randomized into three groups: mice with a sham operation only (control), OVX mice without estradiol (E2) replacement, and OVX mice with E2 replacement (OVX + E2). Cystometry assessment was conducted and cell junction-associated protein zonula occludens-2 (ZO-2) expression was measured after 8 weeks. Voiding interval values (time between voids) were assessed in mice under anesthesia. After measurements, the bladders were removed for proteomic analysis using the label-free quantitative proteomics and liquid chromatography-mass spectrometry technology. Lastly, immunohistochemistry (IHC) and Western blot were used to confirm the location and level, respectively, of ZO-2 expression. RESULTS We identified 73 differentially expressed proteins in the bladder of OVX mice. The OVX mice showed significantly lower voiding interval values. Voiding interval values were significantly higher in the OVX + E2 group than in the OVX group. Urothelial thicknesses in the bladder were also significantly lower in the OVX group than in the control group. E2 replacement reversed the urothelium layers. Additionally, the expression of ZO-2, a tight junction protein, was the most affected by OVX treatment. IHC and Western blot confirmed the downregulation of ZO-2 in the bladder of OVX mice. Expression of ZO-2 protein was significantly increased in OVX + E2 group compared with OVX group. CONCLUSION This exploratory study estimated changes in protein expression and composition in the bladder of OVX mice. These changes may be associated with the molecular mechanisms of OAB.
Collapse
Affiliation(s)
- Huey-Yi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Departments of Obstetrics and Gynecology, Medical Research, and Urology, Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Chao-Jung Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Departments of Obstetrics and Gynecology, Medical Research, and Urology, Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Departments of Obstetrics and Gynecology, Medical Research, and Urology, Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Jing Wang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Departments of Obstetrics and Gynecology, Medical Research, and Urology, Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| |
Collapse
|
|
27
|
Mueller-Gerbes D, Hartmann B, Lima JP, de Lemos Bonotto M, Merbach C, Dormann A, Jakobs R. Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients. Endosc Int Open 2017; 5:E603-E607. [PMID: 28670617 PMCID: PMC5482745 DOI: 10.1055/s-0043-106582] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/20/2017] [Indexed: 02/06/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Daniela Mueller-Gerbes
- Kliniken der Stadt Köln gGmbH – Medizinische Klinik/Gastroenterologie, Köln, Germany,Corresponding author Daniela Mueller-Gerbes Kliniken der Stadt Köln gGmbHKrankenhaus Holweide, Medizinische KlinikNeufelder Str. 3251067 Köln
| | - Bettina Hartmann
- Klinikum Ludwigshafen – Medizinische Klinik C, Ludwighafen, Germany
| | | | - Michele de Lemos Bonotto
- Santa Casa Hospital/Porto Alegre University of Health Sciences, Department of Gastroenterology, Porto Alegre, Brazil
| | | | - Arno Dormann
- Kliniken der Stadt Köln gGmbH – Medizinische Klinik, Köln, Germany
| | - Ralf Jakobs
- Klinikum Ludwigshafen – Medizinische Klinik C, Ludwighafen, Germany
| |
Collapse
|
|
28
|
Abstract
OBJECTIVE Buried bumper syndrome (BBS) is a serious complication in gastrostomy-dependent children. Many need surgical correction. On account of comorbidities, this becomes a high-risk procedure. Our aim was to review the incidence of BBS in children and to identify the risk factors. PATIENTS AND METHODS Retrospective review of patients' records over 10 years, 2006-2015, was carried out. Types of tubes, operative interventions, comorbidities and records were noted. Two-tailed Fisher's exact test was used for statistical analysis. RESULTS A total of 535 patients were reviewed. Overall, 475 had only percutaneous endoscopic gastrostomy (PEG) and 60 had a jejunal extension with percutaneous endoscopic gastrostomy (PEG-J). Twenty-nine patients (PEG-J - 16/26; PEG - 13/26) had a total of 31 BBS episodes. The overall incidence of BBS in our study was 5.4%. The age at presentation ranged from 1 to 18 years (median 8.6 years). All had significant comorbidities (neurodevelopmental 26/29, cardiorespiratory 14/29, genetic 16/29). Overall, 27/29 had two or more comorbidities. The mean time to development of BBS was 1025±634 days. BBS was found in the second or the subsequent tube in four patients with PEGs (P<0.0004) and in 10 PEG-Js (P<0.0001). Twenty-five patients needed laparotomy. There were no postoperative deaths. CONCLUSION In BBS, the two significant risk factors identified were a having PEG-J and two or more previous gastrostomy insertions. Vigilance in documentation and prolonged follow-up to provide regular education to carers can reduce the incidence of this preventable complication.
Collapse
|
|
29
|
The Buried Bumper Syndrome: External Bumper Extraction after Radial Mini Incisions and Replacement through an Adjacent Tract. Case Rep Med 2016; 2016:5379291. [PMID: 27965711 PMCID: PMC5124682 DOI: 10.1155/2016/5379291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/19/2016] [Indexed: 02/07/2023] Open
Abstract
Although considered as a safe method to provide long-term nutritional support, percutaneous endoscopic gastrostomy (PEG) may be complicated by a buried bumper syndrome (BBS), a life-threatening condition. Removal of the PEG tube with its buried bumper and reinsertion of a new PEG tube is often necessary. Since its description in 1988, less than 50 cases of BBS managed by external extraction of the buried bumper have been reported. We report a case of buried bumper that was removed by external traction without the need for endoscopic or laparoscopic treatment but with the need of two radial millimeter skin incisions after abdominal CT study and finally immediate PEG replacement but through an adjacent site.
Collapse
|
|
30
|
Bechtold ML, Mir FA, Boumitri C, Palmer LB, Evans DC, Kiraly LN, Nguyen DL. Long-Term Nutrition. Nutr Clin Pract 2016; 31:737-747. [DOI: 10.1177/0884533616670103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | - Fazia A. Mir
- Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | | | - Lena B. Palmer
- Department of Medicine, Loyola University, Chicago, Illinois, USA
| | - David C. Evans
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Laszlo N. Kiraly
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Douglas L. Nguyen
- Department of Medicine, University of California, Irvine, California, USA
| |
Collapse
|
|
31
|
Abstract
BACKGROUND Buried bumper syndrome (BBS) is a severe complication of percutaneous endoscopic gastrostomy (PEG) based on the overgrowth of gastric mucosa over the inner bumper of a PEG and migration into the gastric or abdominal wall and with a highly variable incidence ranging between 0.9 and > 8 %. However, no classification has yet been described setting the extent of migration of the inner bumper in relation to therapy and the related risk, especially of perforation. OBJECTIVES In the past 12 years 38 patients presented with BBS. Initially, an attempt was made to treat all BBS patients endoscopically. A structured BBS classification into four types for estimation of the therapy risk was developed. METHOD BBS classification: IA: inner bumper partially extrakorporeal or subcutaneous with and without fistula; IB: inner bumper completely extrakorporeal, full thickness focal defect; II: partially visible inner bumper inside the stomach, good degree of mobility; IV: deep type., inner bumper not visible, mucosa without mobility. RESULTS Up to August 2014, examiners with different degrees of experience classified and treated 17 BBS patients according to the algorithm described above (type IA n = 2, type IB n = 2, type II n = 3, type III n = 4 and type IV n = 6). Problem-free endoscopic therapy was possible in all of the patients in whom good mucosa mobilization with or without partial identification of the inner PEG bumper could be previously induced. CONCLUSION The classification serves as an aid and takes both the therapist's experience and patient safety into consideration. In estimating the risk, it considers the following prevailing circumstances: More stringent obligation for patient information under the Patient Rights Act, with presentation of possibly necessary expansion of therapy; the obligation to cite relative alternative treatments; prior check of the resources available (specialist/surgery available yes/no).
Collapse
|
|
32
|
A Case Series: The Identification of Buried Bumper Syndrome With Abdominal Computed Tomography Scan in Two Severely Brain Injured Rehabilitation Patients. PM R 2016; 8:913-6. [DOI: 10.1016/j.pmrj.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 11/19/2022]
|
|
33
|
Lepore M, Marks DJ, Harbord MW. Percutaneous gastrostomy: troubleshooting complications. Br J Hosp Med (Lond) 2016; 77:C86-90. [PMID: 27269765 DOI: 10.12968/hmed.2016.77.6.c86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mario Lepore
- FY1 Doctor in the Department of Medicine, West Middlesex Hospital, Middlesex
| | - Daniel Jb Marks
- ST6 Registrar in Clinical Pharmacology and Therapeutics, University College London Hospital, London
| | - Marcus Wn Harbord
- Consultant Gastroenterologist in the Department of Medicine, Chelsea and Westminster Hospital, London SW10 9NH
| |
Collapse
|
|
34
|
Magaz Martínez M, Martínez Porras JL, López Gómez M, Santiago J, Bernardo C, Abreu L. Endoscopic alternative to buried bumper syndrome secondary to Duodopa ® pump treatment. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:360-362. [PMID: 27242160 DOI: 10.1016/j.gastrohep.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Marta Magaz Martínez
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España.
| | - José Luis Martínez Porras
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Marta López Gómez
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - José Santiago
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Cristina Bernardo
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Luis Abreu
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| |
Collapse
|
|
35
|
Afifi I, Zarour A, Al-Hassani A, Peralta R, El-Menyar A, Al-Thani H. The Challenging Buried Bumper Syndrome after Percutaneous Endoscopic Gastrostomy. Case Rep Gastroenterol 2016; 10:224-32. [PMID: 27462190 PMCID: PMC4939666 DOI: 10.1159/000446018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/07/2016] [Indexed: 01/04/2023] Open
Abstract
Buried bumper syndrome (BBS) is a rare complication developed after percutaneous endoscopic gastrostomy (PEG). We report a case of a 38-year-old male patient who sustained severe traumatic brain injury that was complicated with early BBS after PEG tube insertion. On admission, bedside PEG was performed, and 7 days later the patient developed signs of sepsis with rapid progression to septic shock and acute kidney injury. Abdominal CT scan revealed no collection or leakage of the contrast, but showed malpositioning of the tube bumper at the edge of the stomach and not inside of it. Diagnostic endoscopy revealed that the bumper was hidden in the posterolateral part of the stomach wall forming a tract inside of it, which confirmed the diagnosis of BBS. The patient underwent laparotomy with a repair of the stomach wall perforation, and the early postoperative course was uneventful. Acute BBS is a rare complication of PEG tube insertion which could be manifested with severe complications such as pressure necrosis, peritonitis and septic shock. Early identification is the mainstay to prevent such complications. Treatment selection is primarily guided by the presenting complications, ranging from simple endoscopic replacement to surgical laparotomy.
Collapse
Affiliation(s)
- Ibrahim Afifi
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ahmad Zarour
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ammar Al-Hassani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| |
Collapse
|
|
36
|
Cyrany J, Rejchrt S, Kopacova M, Bures J. Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy. World J Gastroenterol 2016; 22:618-627. [PMID: 26811611 PMCID: PMC4716063 DOI: 10.3748/wjg.v22.i2.618] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/25/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a widely used method of nutrition delivery for patients with long-term insufficiency of oral intake. The PEG complication rate varies from 0.4% to 22.5% of cases, with minor complications being three times more frequent. Buried bumper syndrome (BBS) is a severe complication of this method, in which the internal fixation device migrates alongside the tract of the stoma outside the stomach. Excessive compression of tissue between the external and internal fixation device of the gastrostomy tube is considered the main etiological factor leading to BBS. Incidence of BBS is estimated at around 1% (0.3%-2.4%). Inability to insert, loss of patency and leakage around the PEG tube are considered to be a typical symptomatic triad. Gastroscopy is indicated in all cases in which BBS is suspected. The depth of disc migration in relation to the lamina muscularis propria of the stomach is critical for further therapy and can be estimated by endoscopic or transabdominal ultrasound. BBS can be complicated by gastrointestinal bleeding, perforation, peritonitis, intra-abdominal and abdominal wall abscesses, or phlegmon, and these complications can lead to fatal outcomes. The most important preventive measure is adequate positioning of the external bolster. A conservative approach should be applied only in patients with high operative risk and dismal prognosis. Choice of the method of release is based on the type of the PEG set and depth of disc migration. A disc retained inside the stomach and completely covered by the overgrowing tissue can be released using some type of endoscopic dissection technique (needle knife, argon plasma coagulation, or papillotome through the cannula). Proper patient selection and dissection of the overgrowing tissue are the major determinants for successful endoscopic therapy. A disc localized out of the stomach (lamina muscularis propria) should be treated by a surgeon.
Collapse
|
|
37
|
Berry P, Langlands S, Campbell C, Direkze N, Ala A, Karat I, Keeling P, Taylor J. Removing PEG tubes with 'buried bumpers': Lessons learnt from four patients. Clin Nutr ESPEN 2015; 10:e49-e51. [PMID: 28531458 DOI: 10.1016/j.clnesp.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 10/23/2022]
Abstract
We noted an increase in the number of presentations with dysfunctional PEG tubes due to the 'buried bumper syndrome' (BBS). There is no standard approach to this problem, although case reports exist of endoscopic needle knife excision and forceful pulling. We present a description of our experience in the management of this problem and the lessons learnt by complications or adverse outcomes. Two patients died within 2 weeks of endoscopic therapy. Successful and safe endoscopic removal appears dependent on the depth of the bumper, and this may be gauged by whether or not a wire can be inserted into the gastric lumen via the external portion of the tube. Further experience with radiological estimation of depth is required. The underlying frailty of this group of patients requires careful pre-intervention risk assessment and may favour a conservative approach.
Collapse
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Hepatology and Nutrition, Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Camberley, GU16 7UJ, United Kingdom.
| | - Sarah Langlands
- Department of Gastroenterology, Hepatology and Nutrition, Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Camberley, GU16 7UJ, United Kingdom
| | - Claire Campbell
- Department of Gastroenterology, Hepatology and Nutrition, Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Camberley, GU16 7UJ, United Kingdom
| | - Natalie Direkze
- Department of Gastroenterology, Hepatology and Nutrition, Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Camberley, GU16 7UJ, United Kingdom
| | - Aftab Ala
- Department of Gastroenterology, Hepatology and Nutrition, Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Camberley, GU16 7UJ, United Kingdom
| | - Isabella Karat
- Department of Surgery, Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Camberley, GU16 7UJ, United Kingdom
| | - Peter Keeling
- Department of Anaesthesia, Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Camberley, GU16 7UJ, United Kingdom
| | - Jeremy Taylor
- Department of Radiology, Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Camberley, GU16 7UJ, United Kingdom
| |
Collapse
|
|
38
|
Tenembaum D, Inayat F, Rubin M. Necrotizing fasciitis secondary to acute buried bumper syndrome. Clin Gastroenterol Hepatol 2015; 13:A17-8. [PMID: 25460014 DOI: 10.1016/j.cgh.2014.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 02/07/2023]
Affiliation(s)
- David Tenembaum
- Division of Gastroenterology, Department of Medicine, New York Hospital Queens, Flushing, New York
| | - Faisal Inayat
- Division of Gastroenterology, Department of Medicine, New York Hospital Queens, Flushing, New York
| | - Moshe Rubin
- Division of Gastroenterology, Department of Medicine, New York Hospital Queens, Flushing, New York
| |
Collapse
|
|
39
|
|
|
40
|
ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr 2015; 60:131-41. [PMID: 25023584 DOI: 10.1097/mpg.0000000000000501] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position statement provides a comprehensive guide for health care providers to manage percutaneous endoscopic gastrostomy tubes in a safe, effective, and appropriate way. METHODS Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of evidence, recommendations reflect the expert opinion of the authors. Final consensus was obtained by multiple e-mail exchange and during 3 face-to-face meetings of the gastroenterology committee of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. RESULTS Endoscopically placed gastrostomy devices are essential in the management of children with feeding and nutritional problems. The article focuses on practical issues such as indications and contraindications. CONCLUSIONS The decision to place an endoscopic gastrostomy has to be made by an appropriate multidisciplinary team, which then provides active follow-up and care for the child and the device.
Collapse
|
|
41
|
Curcio G, Granata A, Ligresti D, Tarantino I, Barresi L, Traina M. Buried bumper syndrome treated with HybridKnife endoscopic submucosal dissection. Gastrointest Endosc 2014; 80:916-7. [PMID: 25436407 DOI: 10.1016/j.gie.2014.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/03/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Grabiele Curcio
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Antonino Granata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Luca Barresi
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Mario Traina
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| |
Collapse
|
|
42
|
Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol 2014; 20:8505-8524. [PMID: 25024606 PMCID: PMC4093701 DOI: 10.3748/wjg.v20.i26.8505] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/23/2014] [Accepted: 04/15/2014] [Indexed: 02/06/2023] Open
Abstract
Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.
Collapse
|
|
43
|
Endoscopic approaches to enteral feeding and nutrition core curriculum. Gastrointest Endosc 2014; 80:34-41. [PMID: 24773773 DOI: 10.1016/j.gie.2014.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 12/13/2022]
|
|
44
|
Prospective evaluation of peristomal cutaneous changes among patients with long-term percutaneous endoscopic gastrostomy. Adv Skin Wound Care 2014; 27:260-7. [PMID: 24836616 DOI: 10.1097/01.asw.0000449854.63913.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Percutaneous endoscopic gastrostomy (PEG) is the most commonly used procedure in patients requiring long-term tube feeding. Lack of universal terminology and variations in the description of long-term PEG cutaneous lesions make it difficult for clinicians to interpret, communicate, and formulate a plan of treatment. The authors designed a prospective study to assess the long-term PEG cutaneous lesions and the healthcare utilization. PATIENTS AND METHODS After the PEG procedure, patients followed up for more than 12 months were included. Results of physical examination of the PEG cutaneous lesions were recorded. Laboratory tests, including the standard urine strip test, which detected the presence of bilirubin, microbiologic culture, as well as computed tomography, were applied in patients with PEG long-term cutaneous complications. Unscheduled hospital visits also were recorded. RESULTS The mean follow-up duration after PEG was 28 ± 15 months. Among patients with long-term PEG, 33.6% of the patients had normal skin, 31.0% had skin erythema, 21.2% had wound discharge, 24.8% had granulation tissue, 15.0% had postinflammatory hyperpigmentation, 15.9% had scarring, 5.3% had side torsion, 29.2% had stoma retraction, and 5.3% had bulging lesions. Urine strip test can differentiate gastric content leakage from purulent exudate/serous fluid. All patients with bulging lesions required hospitalization. CONCLUSION Long-term PEG cutaneous problems are common. Appropriate physical examinations and laboratory tests can provide evidence to identify the causes, treat the patients with the PEG cutaneous problems, and decrease the risk for potential unscheduled hospital visits.
Collapse
|
|
45
|
Single-center experience with 1-step low-profile percutaneous endoscopic gastrostomy in children. J Pediatr Gastroenterol Nutr 2014; 58:616-20. [PMID: 24378575 DOI: 10.1097/mpg.0000000000000291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The 1-step low-profile percutaneous endoscopic gastrostomy (1-step PEG) uses a single procedure that allows immediate use of a low-profile device. The aim of the present study was to provide our experience with this device and to analyze complications and outcomes after the initial placement. METHODS We performed a retrospective chart review of pediatric patients with 1-step PEG placement done by our pediatric gastroenterologists between 2006 and June 2011. Patients were studied for a minimum period of 6 months. RESULTS A total of 121 patients were included in our study, with 23% infants. The most common indication for 1-step PEG placement was swallowing dysfunction in children with neurological impairment (49%). Postplacement complications included granulation tissue (52%), cellulitis (23%), leakage (21%), vomiting (17%), tissue breakdown (8%), failed placement (6%), embedded bolster (5%), perforation (0.8%), and bowel obstruction (0.8%). One-step PEG was maintained in 46 patients (38%). In the remaining 75 patients (62%), PEGs were changed to a balloon device in 66 patients and were completely removed in 9 patients. The most common indications for change were damaged PEG (19/75) and issues with size (11/75). The time to change ranged from <1 month to >4 years (14 ± 1.3 months). Sixty-eight percent of 1-step PEG changes/removal was performed with an obturator under brief inhalated anesthesia. CONCLUSIONS The 1-step PEG has complication rates and outcomes comparable with standard PEGs.
Collapse
|
|
46
|
Buried bumper syndrome revisited: a rare but potentially fatal complication of PEG tube placement. Case Rep Crit Care 2014; 2014:634953. [PMID: 24829838 PMCID: PMC4010002 DOI: 10.1155/2014/634953] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/22/2013] [Indexed: 02/02/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.
Collapse
|
|
47
|
Geer W, Jeanmonod R. Early presentation of buried bumper syndrome. West J Emerg Med 2013; 14:421-3. [PMID: 24106531 PMCID: PMC3789897 DOI: 10.5811/westjem.2013.2.15843] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 02/16/2013] [Accepted: 02/27/2013] [Indexed: 12/13/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a relatively safe and effective method of providing nutrition to patients with neurologic deficits or proximal gastrointestinal pathology. Complications that follow this common procedure include dislodgement, dysfunction, infection and aspiration. The “Buried Bumper Syndrome” (BBS) is an infrequent and late complication of PEG tubes that can result in tube dysfunction, gastric perforation, bleeding, peritonitis or death. The emergency physician should be aware of historical and exam features that suggest BBS and distinguish it from other, more benign, PEG-tube related complaints. We report a case of a woman presenting with BBS 3 weeks after having a PEG tube placed.
Collapse
Affiliation(s)
- Walter Geer
- St. Luke's University Hospital, Bethlehem, Pennsylvania
| | | |
Collapse
|
|
48
|
Dhooge M, Gaudric M. Non-surgical access for enteral nutritional: gastrostomy and jejunostomy, technique and results. J Visc Surg 2013; 150:S19-26. [PMID: 23790717 DOI: 10.1016/j.jviscsurg.2013.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gastrostomy is the most efficient and best tolerated method of prolonged nutritional support. Jejunostomy is used more rarely. Indications for both techniques have increased because of progress in insertion techniques under endoscopic or radiologic guidance. The procedure is simple and rapid, performed under simple sedation with a success rate over 95% for gastrostomy, irrespective of the technique. Mortality directly related to the technique is less than 5%, but associated co-morbidity also explains a more variable but often higher 30-day mortality. Local care and maintenance of the catheter should help avoid most of the late complications such as peristomal leaks, local infection or sepsis of the tunneled catheter in the abdominal wall. The main indications are neurologic swallowing disorders, mechanical dysphagia from ENT or esophageal disease, when the expected duration of enteral nutrition is at least longer than 3 weeks. In patients with severe dementia, no benefit for either nutritional status or quality of life has been demonstrated. In all cases, adequate patient information and careful evaluation of the risk/benefit ratio are capital.
Collapse
Affiliation(s)
- M Dhooge
- Service de gastroentérologie, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | | |
Collapse
|
|
49
|
An uncommon complication of percutaneous endoscopic gastrostomy tubes. Clin Gastroenterol Hepatol 2013; 11:xxv. [PMID: 22902280 PMCID: PMC3552138 DOI: 10.1016/j.cgh.2012.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 08/01/2012] [Indexed: 02/07/2023]
|
|
50
|
Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, Fisher L, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Dominitz JA, Cash BD. Adverse events of upper GI endoscopy. Gastrointest Endosc 2012; 76:707-18. [PMID: 22985638 DOI: 10.1016/j.gie.2012.03.252] [Citation(s) in RCA: 245] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 03/20/2012] [Indexed: 12/13/2022]
|