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1
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Abdelfattah T, Kaspar M. Gastroenterologist's Guide to Gastrostomies. Dig Dis Sci 2022; 67:3488-3496. [PMID: 35579798 DOI: 10.1007/s10620-022-07538-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/22/2022] [Indexed: 12/09/2022]
Abstract
Gastroenterologists are frequently consulted for evaluation feeding tube placement, or for management of complications in an existing feeding tube. Though a frequent topic of consultation for GI Fellows, there are few comprehensive resources for feeding tube placement and troubleshooting available. In this review, we discuss different types of feeding tubes, when each should be considered, and various methods and techniques for placement. Considerations for when one type, method, technique, or specialty may be preferred over the other will be discussed. Additionally, we discuss management of the many complications of indwelling feeding tubes. Our goal is to create a comprehensive review for gastroenterologists to cover clinically relevant questions related to feeding tube placement and management.
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Affiliation(s)
- Thaer Abdelfattah
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA, USA.
| | - Matthew Kaspar
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA, USA
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2
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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.
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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
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Gravina AG, Tessitore A, Ormando VM, Nagar F, Romeo M, Amato MR, Dallio M, Loguercio C, Federico A, Romano M, Ferraro F. May chronic cough in chronic obstructive pulmonary disease be a contraindication of Percutaneous Endoscopic Gastrostomy placement: a case report. BMC Gastroenterol 2021; 21:31. [PMID: 33478385 PMCID: PMC7819233 DOI: 10.1186/s12876-021-01603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Percutaneous Endoscopic Gastrostomy (PEG) can involve some complications, despite the good safety of its track record. The Buried Bumper Syndrome (BBS) is a rare, late and dangerous complication that consists in the erosion of the internal bumper through the gastric wall. Case presentation We report the development of BBS in a man with chronic obstructive pulmonary disease (COPD) who had a persistent chronic cough which was prevalently but not solely in the morning and required placement of a PEG tube for continuous infusion of Levodopa/carbidopa intestinal gel for advanced Parkinson's disease. CONCLUSION We believe that COPD with chronic cough while not representing an absolute contraindication to PEG placement, may potentially cause BBS and therefore an appropriate regimen of tube care by expert personnel is mandatory in this setting.
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Affiliation(s)
- A G Gravina
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy.
| | - A Tessitore
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - V M Ormando
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - F Nagar
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Romeo
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - M R Amato
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - M Dallio
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - C Loguercio
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - A Federico
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - M Romano
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - F Ferraro
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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4
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Ayas MF, Hoilat GJ, Affas S. An Early Presentation of Buried Bumper Syndrome. Cureus 2020; 12:e10969. [PMID: 33209527 PMCID: PMC7667611 DOI: 10.7759/cureus.10969] [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] [Indexed: 11/05/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a well-established and successful method of nutritional delivery. Complications, although rare, are divided into early or late. Buried bumper syndrome (BBS) is usually a late complication of PEG tube insertion and can cause many issues such as pressure necrosis, peritonitis, and septic shock. Endoscopic evaluation is the definitive diagnosis, and treatment depends on each patient and the degree of depth of disc migration. We present to you a case of buried bumper syndrome in a 66-year-old female that was initially thought to be complicated with peritonitis, and surprisingly occurring only one week after initial PEG tube placement.
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Affiliation(s)
- Mohamad F Ayas
- Internal Medicine, Ascension St. John Hospital and Medical Center, Detroit, USA
| | - Gilles J Hoilat
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Saif Affas
- Internal Medicine, Ascension St. John Hospital and Medical Center, Detroit, USA
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5
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Balekuduru AB, Bongu SS, Mandalapu NB, Ramachandraiah G, Khemka VK, Subbaraj SB. Fluoroscopy-Assisted Percutaneous Endoscopic Gastrostomy (F-PEG)—Single-Center Experience and Outcome. JOURNAL OF DIGESTIVE ENDOSCOPY 2020. [DOI: 10.1055/s-0040-1716580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractBackground Gastrointestinal route is considered for feeding in subjects who are unable to swallow, either as a temporary or permanent option. Percutaneous endoscopic gastrostomy (PEG) is the preferred mode for long-term enteral nutrition. The aim was to study the outcome of protocol-based PEG placement in a tertiary medical center.Materials and Methods All the patients who underwent PEG placement between January 2017 and December 2019 were included in the retrospective study. Study variables were entered into a uniform structured proforma. The procedure was done by two people using Ponsky-Gauderer pull-technique. Fluoroscopy guidance was considered for placement in special situations. Post-procedure, all the patients were regularly followed as per protocol to evaluate for adverse events.Results One hundred and eighteen patients with placement of PEG were included in the study. The mean age of the patients was 49.6 ± 7 years with 67.8% males. The most common indication of PEG was inability to swallow associated with head injury (43, 36.4%), followed by carcinoma esophagus (35, 29.8%) and stroke (24, 20.3%). Fluoroscopy was useful in 38 (32%) for PEG site identification. Tube dislodgement (16, 13.5%) and aspiration pneumonia (20, 16.9%) were the common adverse events. Age more than 60 years and dysphagia in neurologic disorders accounted for more than 60% of adverse events. Forty-nine (42%) of the PEG patients expired due to either primary illness or due to sepsis after a median time of 139 days (range: 32–288 days). There was no difference in the survival in patients with or without PEG-related complications (p = 0. 74).Conclusions Fluoroscopy assistance helps in accurate PEG placement in one third. Age > 60 years and dysphagia in neurologic disorders were independent risk factors associated with PEG tube complications.
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Affiliation(s)
| | - Shruti Sagar Bongu
- Department of Gastroenterology, M.S. Ramaiah Hospitals, Bangalore, Karnataka, India
| | | | | | - Vinit Kumar Khemka
- Department of Gastroenterology, M.S. Ramaiah Hospitals, Bangalore, Karnataka, India
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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.
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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.
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7
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Jeong Y, Lee J, Kim KA, Park CM. Medical Devices of the Abdomen and Pelvis and Their Complications: A Radiologic Atlas. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:863-885. [PMID: 36238189 PMCID: PMC9432218 DOI: 10.3348/jksr.2020.81.4.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/30/2019] [Accepted: 10/20/2019] [Indexed: 11/15/2022]
Abstract
의료기구들이 발달하면서 복부 및 골반 내에 이식되거나 거치되는 의료기구들이 다양해졌다. 흔하게 사용되는 기구들의 영상의학 소견은 영상의학과 의사들에게 매우 익숙하지만, 상대적으로 사용 빈도가 낮거나 새로운 형태의 기구들의 영상의학 소견은 잘 알려져 있지 않다. 또한 환자에 대한 임상정보가 제한적일 경우 이런 새로운 형태의 의료기구들은 잘못 해석되거나 놓치기 쉽다. 그러므로 복부 및 골반 내 의료기구들의 영상의학 소견을 인지하는 것은 기구들의 올바른 위치를 평가하고, 이와 관련된 합병증을 평가하는데 있어 매우 중요하다. 본 논문에서는 다양한 복부 및 골반 내 의료기구들과 이와 관련된 합병증의 영상의학 소견을 소개하고자 한다.
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Affiliation(s)
- Yaewon Jeong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Min Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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8
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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.
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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
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9
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Hoang PT, Menias CO, Niemeyer MM. Percutaneous Gastrostomy Tube Placement: Recognizing When Things Go Wrong. Semin Intervent Radiol 2019; 36:264-274. [PMID: 31435135 PMCID: PMC6699954 DOI: 10.1055/s-0039-1693983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Percutaneous radiologic gastrostomy is a commonly performed, minimally invasive procedure for long-term enteral access in patients with a variety of conditions. Compared with other methods, it is less invasive, less costly, and safe, with a high technical success rate. The risk of complications is low, and most require only conservative management. Early, accurate diagnosis of more severe complication is crucial, as these may require prompt intervention. Therefore, radiologists should understand the imaging features, clinical presentation, and management of gastrostomy-related complications. This article will review the indications for long-term enteral access, discuss the available methods, summarize the percutaneous radiologic technique, and highlight the associated complications from gastrostomy placement.
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Affiliation(s)
- Peter T. Hoang
- Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Christine O. Menias
- Division of Abdominal Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Matthew M. Niemeyer
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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10
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Satiya J, Marcus A. The Buried Bumper Syndrome: A Catastrophic Complication of Percutaneous Endoscopic Gastrostomy. Cureus 2019; 11:e4330. [PMID: 31183309 PMCID: PMC6538410 DOI: 10.7759/cureus.4330] [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: 03/13/2019] [Accepted: 03/27/2019] [Indexed: 01/24/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a safe and widely used method of providing enteral nutrition in patients unable to tolerate per oral intake. Common complications include gastrointestinal bleeding, dislodgment, perforation, abdominal wall abscess, and aspiration. "Buried bumper syndrome" (BBS) is a rare but potentially fatal complication resulting in malfunction of the tube, gastric perforation, bleeding, and peritonitis. Gastroenterologists should be cognizant of the clinical presentation and treatment of a buried bumper. We report a case of a 56-year-old woman who presented with coffee-ground emesis and was managed with the placement of a gastro-jejunal tube.
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Affiliation(s)
- Jinendra Satiya
- Internal Medicine, University of Miami, John F Kennedy Regional Campus, Atlantis, USA
| | - Akiva Marcus
- Gastroenterology, University of Miami, John F Kennedy Regional Campus, Atlantis, USA
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11
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Pinho J, Libânio D, Pimentel-Nunes P, Dinis-Ribeiro M. The Challenging Acute Buried Bumper Syndrome: A Case Report. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:151-153. [PMID: 29761152 PMCID: PMC5939786 DOI: 10.1159/000485104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/08/2017] [Indexed: 01/12/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients requiring long-term enteral nutrition. Major complications related to the procedure are rare. Buried bumper syndrome is a late major complication, occurring in 0.3-2.4% of patients. Although considered a late complication, it can rarely occur in an acute setting early after the procedure. We present the case of an early buried bumper syndrome, presenting 1 week after PEG tube placement, with local stoma infection associated with an infected cavity within the abdominal wall with feeding content, successfully managed with antibiotic therapy and PEG tube repositioning through the original track.
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Affiliation(s)
- Juliana Pinho
- Gastroenterology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Diogo Libânio
- Gastroenterology Department, Instituto Portugu's de Oncologia do Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Instituto Portugu's de Oncologia do Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Instituto Portugu's de Oncologia do Porto, Porto, Portugal
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12
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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
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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.
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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
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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.
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Bishop S, Reed WM. The provision of enteral nutritional support during definitive chemoradiotherapy in head and neck cancer patients. J Med Radiat Sci 2015; 62:267-76. [PMID: 27512573 PMCID: PMC4968562 DOI: 10.1002/jmrs.132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 02/05/2023] Open
Abstract
Combination chemoradiation is the gold standard of management for locally advanced squamous cell carcinomas of the head and neck. One of the most significant advantages of this approach to treatment is organ preservation which may not be possible with radical surgery. Unfortunately, few treatments are without side-effects and the toxicity associated with combined modality treatment causes meaningful morbidity. Patients with head and neck cancer (HNC) may have difficulties meeting their nutritional requirements as a consequence of tumour location or size or because of the acute toxicity associated with treatment. In particular, severe mucositis, xerostomia, dysgeusia and nausea and vomiting limit intake. In addition to this, dysphagia is often present at diagnosis, with many patients experiencing silent aspiration. As such, many patients will require enteral nutrition in order to complete chemoradiotherapy (CRT). Feeding occurs via catheters placed transnasally (nasogastric tubes) or directly into the stomach through the anterior abdominal wall (percutaneous gastrostomy tubes). In the absence of clear evidence concerning the superiority of one method over another, the choice of feeding tube tends to be dependent on clinician and patient preference. This review examines key issues associated with the provision of enteral nutritional support during definitive CRT in HNC patients, including feeding methods, patient outcomes and timing of tube insertion and use.
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Affiliation(s)
- Sarah Bishop
- Illawarra Cancer Care CentreDepartment of Radiation Oncology, Wollongong HospitalWollongongNew South WalesAustralia
- Radiation Oncology DepartmentNelune Comprehensive Cancer CentrePrince of Wales HospitalRandwickNew South WalesAustralia
| | - Warren Michael Reed
- Medical Image Optimisation and Perception GroupDiscipline of Medical Radiation SciencesFaculty of Health SciencesThe University of SydneyLidcombeNew South WalesAustralia
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Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014; 20:7739-7751. [PMID: 24976711 PMCID: PMC4069302 DOI: 10.3748/wjg.v20.i24.7739] [Citation(s) in RCA: 325] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/26/2014] [Accepted: 04/08/2014] [Indexed: 02/06/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the "pull" technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Despite the mentioned PEG tube placement complications, this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system.
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