Buried bumper syndrome: A critical analysis of endoscopic release techniques

Table 1 Advantages and disadvantages of each endoscopic technique

No.	Technique	Cases1	Advantages	Disadvantages
1	The “push”[16,17]		Need of readily available endoscopic instruments	Applied to gastrostomy tubes removable only through the mouth
2	The “needle-knife”[1,2,18]	17	Easier to use through the endoscope, a common instrument	Applied to gastrostomy tubes removable only through the mouth; risk of bleeding/perforation
3	The “push-pull T”[19,20]	18	Need of readily available endoscopic instruments	Applied to gastrostomy tubes removable only through the mouth; need of multiple sessions, traumatic
4	The “new PEG against the old”[3,21,22]		Simple to be applied	Applied only in gastrostomy tubes able to be removed by traction
5	The “snare”[11,23]		Need of readily available endoscopic instruments	Applied to gastrostomy tubes removable only through the mouth
6	The “papillotome”[4,24,25]	112	The largest series published[24]	Applied to gastrostomy tubes removable only through the mouth; too long/not easily manipulated, lack of rigidity; difficult in handling endoscopic instruments out of the endoscope
7	The “Flamingo”[26]	58	Commercially available	Applied to gastrostomy tubes removable only through the mouth; bleeding/laceration/sepsis; Cost???
8	The “ESD devices”[12,29-31]		Easy to handle in experienced hands	Applied to gastrostomy tubes removable only through the mouth; not standard equipment; need of experience in ESD; Cost???
9	The “balloon dilator”[32,33]		Instruments readily available in an endoscopic suite	Applied to gastrostomy tubes removable only through the mouth
10	The “NOTES”[34,35]	2	Peritoneoscopy through a natural orifice (mouth)	Applied to gastrostomy tubes removable only through the mouth; no longer in clinical practice

¹Number of cases referred to have been treated by the author.

PEG: Percutaneous endoscopic gastrostomy; ESD: Endoscopic submucosal dissection.