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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2016; 22(2): 618-627
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.618
Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy
Jiri Cyrany, Stanislav Rejchrt, Marcela Kopacova, Jan Bures
Jiri Cyrany, Stanislav Rejchrt, Marcela Kopacova, Jan Bures, 2nd Department of Internal Medicine - Gastroenterology, University Hospital Hradec Kralove, 50005 Hradec Kralove, Czech Republic
Jiri Cyrany, Stanislav Rejchrt, Marcela Kopacova, Jan Bures, Faculty of Medicine in Hradec Kralove, Charles University in Prague, 50005 Hradec Kralove, Czech Republic
Author contributions: Cyrany J wrote the article; Rejchrt S and Kopacova M revised the article critically for important intellectual content; Bures J revised and finally approved the article.
Supported by Project PRVOUK P37-08 from Charles University Prague, Czech Republic.
Conflict-of-interest statement: The authors disclose no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jiri Cyrany, MD, PhD, 2nd Department of Internal Medicine - Gastroenterology, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic. jiri.cyrany@email.cz
Telephone: +420-49-5834240 Fax: +420-49-5834785
Received: April 29, 2015
Peer-review started: May 7, 2015
First decision: June 3, 2015
Revised: June 25, 2015
Accepted: October 23, 2015
Article in press: October 26, 2015
Published online: January 14, 2016
Processing time: 252 Days and 15.5 Hours
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.

Keywords: Buried bumper syndrome; Percutaneous endoscopic gastrostomy; Endoscopy; Complication; Enteral nutrition

Core tip: This review summarizes current knowledge about buried bumper syndrome, with emphasis on endoscopic diagnosis and therapy. Proper patient selection and endoscopic dissection of the overgrowing tissue are the major determinants for successful endoscopic therapy.