Delayed Diagnosis of Buried Bumper Syndrome When Only the Jejunostomy Extension is Used in a Percutaneous Endoscopic Gastrostomy-jejunostomy Levodopa-carbidopa Intestinal Gel Delivery System.

Ahmad A Abu-Heija,Usama Abu-Heija,Maher Tama,Mowyad Khalid,Omar Al-Subee

doi:10.7759/cureus.4568

Abstract

Direct intrajejunal levodopa-carbidopa intestinal gel (LCIG) administered through a percutaneous endoscopic gastrostomy (PEG) with a jejunal extension tube (PEG-J) is an FDA-approved modality for treatment of patients with advanced Parkinson’s disease (PD). Buried bumper syndrome (BBS) is a rare complication associated with PEG tubes inserted for drug administration or enteral feeding. The syndrome is diagnosed endoscopically revealing burial of the internal bumper in the gastric wall, causing numerous serious complications. When only the J extension of a PEG-J is used to deliver medications, and the G tube is not utilized, a delay in the diagnosis of BBS can occur. This is likely as the small caliber J extension tube remains patent and functional. We present the case of an elderly patient with advanced PD on LCIG therapy, who presented with a dislodged J-tube from a PEG-J system. Endoscopy revealed BBS that had likely developed prior to dislodgment of J-extension and despite a conservative approach, the internal bumper needed to be surgically extracted to prevent further complications.

Highlights

Percutaneous endoscopic gastrostomy (PEG) tubes have seen an increasing use globally in the last few decades as means for enteral nutrition, drug delivery, and gastric decompression, with estimates of an excess of 250,000 percutaneous endoscopic gastrostomy (PEG) tubes inserted annually in the United States alone [1]
Buried bumper syndrome (BBS) is a rare complication associated with PEG tubes inserted for drug administration or enteral feeding
We present the case of an elderly patient with advanced Parkinson’s disease (PD) on levodopa-carbidopa intestinal gel (LCIG) therapy, who presented with a dislodged jejunal extension tube (J-tube) from a PEG tubes with J-extension (PEG-J) system

Summary

Introduction

Percutaneous endoscopic gastrostomy (PEG) tubes have seen an increasing use globally in the last few decades as means for enteral nutrition, drug delivery, and gastric decompression, with estimates of an excess of 250,000 PEG tubes inserted annually in the United States alone [1]. Buried bumper syndrome (BBS) is a rare complication associated with PEG tube placement, with an approximate incidence of 0.3%-2.4% [1,2]. How to cite this article Abu-Heija A A, Tama M, Abu-Heija U, et al (April 30, 2019) Delayed Diagnosis of Buried Bumper Syndrome When Only the Jejunostomy Extension is Used in a Percutaneous Endoscopic Gastrostomyjejunostomy Levodopa-carbidopa Intestinal Gel Delivery System. The patient had undergone successful PEG tube placement (Figure 1A) and the introduction of a trans-gastric jejunostomy tube extension (Figure 1B) for direct jejunal administration of LCIG. Due to the necessity of resuming LCIG, a new PEG-J was inserted endoscopically through the existing open wound in the anterior abdominal wall (Figure 3A, 3B). LCIG administration was continued and the patient was seen on follow-up after four weeks and at six months, with sustained normal functioning of the new PEG-J system

Discussion

Conclusions

Disclosures

Worth PF