Endoscopic Treatment of the Buried Bumper Syndrome

Abstract

Listen

Translate article

Endoscopic Treatment of the Buried Bumper Syndrome Bernhard Rieder, Albrecht Pfeiffer Introduction: The buried bumper syndrome is a rare but serious complication in patients with percutaneous endoscopic gastrostomy (PEG). While a variety of non-operative techniques have been used to manage buried bumper syndrome, in most cases surgical intervention is necessary to rectify the problem. We report on an endoscopic method using a Savary dilator over a guidewire for the treatment of the buried bumper syndrome. Method: 8 patients (4 females, 4 males, 60-90 years) were admitted to our gastroenterology unit with buried bumper syndrome. The PEG-tubes had been placed 4 (2-6) years earlier. The manifestations of the buried bumper syndrome included inability to infuse feeding solutions and swelling, pain and leakage above the PEG tube. All attempts to grasp the bumper with a snare or to dislodge it by applying pressure on the PEG tube externally proved futile. The PEG tube was cut 2 to 3 cm above the skin level. Under endoscopic visualization, a Savary dilator guidewire was inserted through the gastrostomy tube into the lumen of the stomach. The guidewire was grasped with a snare and withdrawn through the mouth. The endoscope was reinserted into the stomach. In 4 patients, where the bumper was overgrown by gastric mucosa, endoscopic incision using a needle knife was necessary. Savary dilators (24 F) were passed over the guidewire to displace the bumper together with the remnant of the tube into the stomach. The bumper was snared and removed endoscopically. Results: The buried bumpers could be removed in all 8 patients. In 7 patients, the procedure was tolerated without any incident. In one patient, a bleeding episode induced by the needle knife procedure was treated endoscopically. A new PEG was placed in all 8 patients within 6 days. Conclusion: The described endoscopic method using Savary dilators over a guidewire allows safe removal of embedded PEG bumpers and might replace surgery in the treatment of the buried bumper syndrome.