The Buried Bumper Syndrome As a Long-Term Complication of Percutaneous Endoscopic Gastrostomy (PEG): Management in a Tertiary Care Center

Abstract

The buried bumper syndrome (overgrowth of the internal bumper by gastric mucosa) is a long-term complication of PEG. It often leads to loss of function of the PEG and to local complications like local infection and pain, which in turn results in the need to remove and replace the PEG. We analyzed the frequency, management and consequences of this syndrome in our tertiary care center. Methods: Retrospective analysis of all patients with buried bumper syndrome in our center since 1998. Results: Since 1998 31 pts. with buried bumper syndrome were observed. Regarding the average number of about 230 inserted PEGs per year this results in a mean frequency of 1.9%/year. However, there was a substantial rise of the frequency over time (from 0.8% in 1998 to 3.6% in 2004). Buried bumper syndrome was detected due to local infection in 17 pts. (55%), due to loss of function of PEG in 11 pts. (35%) and due to inability to move the PEG in 3 pts. (10%). The removal of PEG was performed endoscopically using a needle knife in 14 pts. (35%), transcutaneously with the Staritz-method in 4 pts. (13%) and surgically in 8 pts. (26%). In 5 pts. (16%) the buried bumper was left in place because of high OP-risk after a median number of 2 (1-3) unsuccessful endoscopic removal attempts and a new PEG was inserted next to the old PEG. The median number of sessions needed for endoscopic removal was 2 (1-3), while transcutaneous removal was possible in one session in all patients. Surgical removal was preceded by a mean of 1 (1-2) unsuccessful endoscopic removal attempts. Removal of buried bumpers was accompanied by complications in 9 pts. (29%): Bleeding during endoscopic removal procedures in 6 pts., severe local infection after surgical removal in 1 pt. and 2 disconnected bumpers which had to be left in place in 2. All these complications could be managed without serious consequences for the pts. Since the method of transcutaneous removal was introduced in 2004 no surgical removal was needed up to now. Conclusion: The buried bumper syndrome is a still rare, but increasing and relevant complication in the long term after PEG insertion. Therapy is often complex, time consuming and associated with a high number of complications, but in the majority of pts. non-surgical management is possible.