Buried Bumper Syndrome Research Articles

Migración Recurrente del Botón de Gastrostomía: "Síndrome de Buried Bumper"

At present, gastrostomy has changed the treatment of children under ambulatory nutritional support, as well as in the long term nutrition of children with chronic pathologies. The percutaneous endoscopic gastrostomy (PEG) is the chosen procedure for its safety and its minimal invasiveness. In spite of this it is not exempt of complications, such as the migration of the gastrostomy button of the abdominal or gastric wall, known as the buried bumper syndrome. Clinical Case: to illustrate this complication we present the case of a pre-school patient who underwent 2 endoscopic gastrostomies and on both occasions presented with this complication. Conclusions : In spite of the fact that we believe that PEG has many advantages, it nevertheless is an invasive procedure, with complications ranging from wound infection to buried bumper syndrome. Therefore it is necessary to study the risks-benefits of each particular case to avoid unnecesary morbidity.

Comparison of two percutaneous radiological gastrostomy tubes in the nutritional management of ALS patients

Patient care and minimizing complications post gastrostomy have to date received little attention in ALS patients. We compare the complications associated with pigtail and mushroom type percutaneous radiological gastrostomy tubes in this patient group. Patients requiring PRG received either Wills-Oglesby or the skin level Entristar. Retrospective review of the clinical notes was performed capturing demographic data, peristomal infection, tube displacement, tube failure, nutritional status, site of disease onset, and survival. Thirty-five patients (Group 1) had the Wills-Oglesby tube of which 14 (40%) tubes required replacement. The Entristar tube was inserted in 29 patients (Group 2) where 8 (28%) required replacement (NS). The incidence of infection was significantly lower with the Entristar tube, (p<0.001). The mean time to tube removal in Group 2 was 223 days (SD 147; range 71-494 days) due to 'buried bumper syndrome'. We conclude that the Entristar skin level gastrostomy tube is associated with a reduction in peristomal infection, tube failure and blockage compared with the Wills-Oglesby tube.

Buried bumper - a new method of non-surgical removal

Buried bumper syndrome is a rare complication among patients with PEG for long-term feeding. Tight fixation of the external bumper causes pressure necrosis beneath the internal bumper. This leads to the internal bumper's penetration of the deeper gastric wall, where it is completely overgrown by gastric mucosa. A method is shown how the buried bumper can be removed without an operation. This method was used successfully in seven patients. The buried bumper syndrome can be avoided with careful precautions.

Methicillin resistant staphylococcus aureus—related gastrostomy tube colonization complicated by anterior abdominal wall sepsis in association with buried bumper syndrome: a rare complication

Methicillin resistant staphylococcus aureus—related gastrostomy tube colonization complicated by anterior abdominal wall sepsis in association with buried bumper syndrome: a rare complication

METHICILLIN RESISTANT Staphylococcus aureus—RELATED GASTROSTOMY TUBE COLONIZATION COMPLICATED BY ANTERIOR ABDOMINAL WALL SEPSIS IN ASSOCIATION WITH BURIED BUMPER SYNDROME: A RARE COMPLICATION

Methicillin resistant staphylococcus aureus —related gastrostomy tube colonization complicated by anterior abdominal wall sepsis in association with buried bumper syndrome: a rare complication

Buried bumper syndrome: treatment guided by catheter probe US

Background: The “buried bumper syndrome,” caused by migration of the internal bumper into the gastric walls, is a rare complication of PEG. The internal bumper becomes completely overgrown by gastric mucosa. Localization of internal bumpers in relation to the layers of the gastric wall was investigated with catheter probe US to define the optimal therapeutic strategy for PEG removal. Methods: Eleven patients with the buried bumper syndrome were encountered within 40 months. The internal bumper was localized endosonographically within the gastric and abdominal layers with a 20 MHz catheter US probe. In case of intramural localization, endoscopic extraction was attempted; extramurally located bumpers were removed surgically. Observations: In 8 patients with an intramural internal bumper, endoscopic PEG removal was achieved without major complication. Mild bleeding after needle knife incision in one case was successfully treated by clip application. In the 3 remaining patients with extragastric localization of the bumper, the PEG was surgically removed. Conclusion: The position of the internal bumper within the layers of the gastric and abdominal wall can be determined by EUS with high-resolution catheter probes, thereby indicating the appropriate therapeutic approach.

Two-Step Approach In The Treatment Of Buried Bumper Syndrome As A Late Complication Of Percutaneous Endoscopic Gastrostomy

An 84-year-old woman with PEG for the last 1.5 years was referred to our institution with the complaint of tube malfunction. The buried bumper syndrome with a subcutaneous abscess was diagnosed on physical examination and these findings were confirmed by ultrasound. There were marked tenderness, edema, erythema, and swelling indicating a cellulitis at the skin around the tube entering. Upper gastrointestinal endoscopy showed a complete mucosal healing with a scar tissue at the previous PEG site in the gastric wall. The tube was removed with an abdominal incision under local anesthesia and the abscess was drained. In order to achieve a regression of infection and to avoid a progression to more serious soft tissue infections such as necrotizing fasciitis, a broad-spectrum antibiotherapy was initiated. Nutritional support was provided via naso-gastric tube until the tube renewal. A PEG tube was re-inserted by pull method at another site after a 7-day interval. The patient has been symptom-free during 2 months of follow-up.

The buried bumper syndrome: A simple management approach in two patients

PEG tube placement is widely used for enteral nutrition.1,2 It is associated with a number of immediate and delayed complications, including the buried bumper syndrome in which the internal bumper migrates from the gastric lumen and lodges in the gastric wall or anywhere along the gastrostomy tract.3-7 The buried bumper syndrome occurs in approximately 1.6% of patients who undergo PEG tube placement. Inability to infuse feeding solution through the tube often leads to the diagnosis. Other manifestations include swelling, pain, and leakage around the PEG tube.

Enteral feedings with comfort and safety.

Patients who are unable to eat by mouth can be fed in a manner that maintains the structural and functional integrity of the gastrointestinal tract. The appropriate choice of type of feeding tube to use is based on the reasons patients need to be tube fed and the expected duration of need for the tube. Once the tubes are placed, verification of placement is critical for safe use. Patients, family caregivers, and staff must assess for potential complications. Misplacement is the most common problem of feeding tubes. Life-threatening complications can include "refeed syndrome" and "buried bumper syndrome." Additional threats include contaminated tube feeding and inappropriate medication administration. Feeding too rapidly into the small intestine can cause necrosis of the small bowel. To maintain patient comfort, site care is critical. Nasogastric tubes can cause permanent deformity of the nares. Gastric drainage on the skin can cause painful excoriation that is difficult to manage. With careful monitoring of tube feedings, positive nutritional status can be achieved. A positive nutritional status assists in promoting health and immune function.

Buried bumper syndrome: Old problem, new tricks

Buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy (PEG). The condition results from excessive tension between the external and internal bumpers. Several attributing factors may predispose the internal bumper to embedding in the gastric or abdominal wall. Surgical treatment was a reasonable approach to remove the internal bumper. The novel endoscopic method of exposing the buried internal bumper and subsequent removal using a needle knife sphincterotome has been reported. A radiological technique of removing the buried internal bumper was also recently described. We report two cases of buried soft-tip bumpers that were easily removed by external traction without the need for surgical, invasive endoscopic or radiological methods of removal. In the first case, the original tract was incompletely closed, allowing a new PEG tube to be inserted via the same route. In the second case, an adjacent site was used for the re-insertion as the original tract had completely closed. Both cases illustrate the ease with which the buried bumpers were removed. The advent of externally removable internal bumpers reduces the need for endoscopic or surgical removal of buried internal bumpers.

Percutaneous endoscopic gastrostomy (PEG)

Percutaneous endoscopic gastrostomy (PEG), although a standard method for long-time enteral nutrition, still leaves uncertainty about details in indication, technique and complications. Based on own experiences (approximately 1000 PEG's and 170 EPJ's in the last 10 years) these topics are discussed. As new indications the PEG for decompression in chronic intestinal obstruction and the questionable relative contraindications ascites, peritoneal carcinosis and Morbus Crohn are discussed. The common thread-pull through-technique is recommended in a slightly modified variation, according to direct puncture techniques of small intestine: the cannulas inserted in the intestine are fixed by an endoscopic alligator forceps, thus facilitating precise puncture and raising safety for the patient due to avoidance of dislocation. As complications local infections, implantation metastases and the buried bumper syndrome have to be mentioned and avoided. Alternative methods for PEG and different exchange systems for more comfort for the patients are discussed finally.

A case of buried bumper syndrome that is developed relatively early after percutaneous endoscopic gastrostomy

A case of buried bumper syndrome that is developed relatively early after percutaneous endoscopic gastrostomy

The buried bumper syndrome (BBS). Differential therapeutic approach and prevention possibilities

The buried bumper syndrome (BBS). Differential therapeutic approach and prevention possibilities

The buried-bumper syndrome (BBS) may be related to the size and morphology of the internal bumper

The buried-bumper syndrome (BBS) may be related to the size and morphology of the internal bumper

The Buried Bumper Syndrome Complicating Percutaneous Endoscopic Gastrostomy in Children

The Buried Bumper Syndrome Complicating Percutaneous Endoscopic Gastrostomy in Children

高齢者における経皮内視鏡的胃ろう造設術による合併症予防のための追加処置の有用性に関する検討

From September 1995 through May 1999, percutaneous endoscopic gastrostomy (PEG) was performed in 47 elderly patients, aged 65 to 93 (average 78.9). Several treatments were additionally performed to prevent serious complications in these cases, and their usefulness and problems were investigated. Gastropexy was performed to prevent peritonitis in cases of self-removal of tubes in the acute stage. Intraoperative fluoroscopy was used prevent perforation of the intestines. However, re-insertion of the endoscopic, which was necessary with the push method, was omitted to reduce the burden on the patients. In patients with tube troubles in the chronic stage such as the buried bumper syndrome or self-removal, the existing fistula was preserved and the gastrostomy was reconstructed using a narrow polyvinyl chloride tube and a flexible guide wire to prevent peritonitis by erroneous insertion of the tube. In terms of results, gastropexy was useful to prevent peritonitis in one patient with early self-removal of the tube. Data to evaluate the usefulness of fluoroscopy in preventing perforation of the intestine were insufficient, so more patients need to be studied in the future. Even when confirmation of the location of the internal bumper by endoscopy was omitted, there was no case of poor traction of the bumper, so this procedure seems unnecessary. Review of tube troubles, in the chronic stage revealed no case of peritonitis caused by erroneous insertion of tubes or erroneous injection of nutrients with our reconstruction methods, and complete reconstruction of the gastrostomy with preservation of the existing fistula appeared to be possible. However, those additional treatments require extension of the operation time and rise in cost with increased use of medical instruments, so the indications should be carefully considered.

The buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy

The buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy

Buried Bumper Syndrome as a Rare Complication of Percutaneous Endoscopic Gastrostomy

Abstract: Percutaneous Endoscopic Gastrostomy (PEG), which can be performed under local anesthesia and does not require laparotomy, has become an accepted means of providing long‐term nutritional support for patients who cannot swallow. PEG can be successfully performed in 10–20 minutes with minimal invasion. Although the incidences are low, some complications with PEG have been reported. We describe herein a patient who developed an early complication of PEG in which the internal bumper became buried in the gastric wall. The buried bumper was immediately removed under local anesthesia, and a new PEG tube was successfully placed. There have also been reports of tube migration into the appears to result from excessive traction on the tube with subsequent ischemic necrosis of the gastric mucosa and pressure necrosis. Careful management of the tube is needed prevent this complication.

Percutaneous endoscopic gastrostomy: A long-term follow-up

Percutaneous endoscopic gastrostomy (PEG) is the preferred method of long-term tube feeding, but only a few studies describe a long-term follow-up. The purpose of this study is to analyze the follow-up of PEG enteral feeding patients in the long term, and to report on the complication and survival rates. Between January 1991 and June 1995, we studied 136 patients (49% cancer and 51% non-cancer patients; male = 68%, female = 32%) after PEG insertion. One hundred twenty-eight patients had a long-term follow-up of over 31 d. The mean duration of PEG feeding was 277 ± 358 d (range 31–1590): 17% of patients returned to oral feeding, 34% continued enteral nutrition, and 49% died. Major complications occurred in 3% of the patients: 1 aspiration pneumonia, 1 subcutaneous abscess, 2 buried bumper syndrome. Minor complications arose in 14% of our cases: 8 tube blockages, 4 tube dislodgements, 6 site infections. For the whole group of 136 patients, survival probabilities after PEG insertion at 1, 6, 12, and 24 mo were 90.5%, 52%, 42%, and 35%, respectively. After 180 d, the difference in survival probabilities between cancer and non-cancer patients became significant ( P < 0.02). Median survival probability was 64% for non-cancer and 39% for cancer patients, and this trend did not change over 2 y.

Another approach to the buried bumper syndrome

We read with interest the report by Ma et al.1Ma MM Semlacher EA Fedorak RN et al.The buried gastrostomy bumper syndrome: prevention and endoscopic approaches to removal.Gastrointest Endosc. 1995; 41: 505-508Abstract Full Text PDF PubMed Scopus (89) Google Scholar concerning the buried gastrostomy bumper syndrome. We observed this complication in a 24-year-old man suffering from mesencephalic syndrome type IV caused by head trauma. In order to feed the patient and to avoid aspiration, PEG was performed by the push method with a Sacks-Vine gastrostomy kit in December 1988. Seven years later, in April 1995, we evaluated the patient for a nonfunctioning gastrostomy tube. At inspection the skin surrounding the PEG tube was erythematous and indurated, and an attempt to inject water through the tube resulted in reflux around the tube site. At endoscopy a submucosal lesion positive for the “blind sign” was seen and the mucosa of the anterior wall of the gastric body appeared partly eroded. The inner bumper was not visible endoscopically. External traction on the tube produced a slight dimpling of the anterior gastric wall. A guide wire was passed through the gastrostomy tube and entered the stomach. The incision of the mucosa covering the dome with a needle knife did not allow the exposure of the inner bumper. Finally, a small cutaneous incision, performed under local anesthetic, was made on each side of the tube down to the bumper. The tube and bumper were removed, leaving the guide wire in place, without opening the peritoneum. Graduated dilators were inserted over the wire to enlarge the stoma to 22F. An 18F introducer gastrostomy tube was inserted over the wire, the balloon inflated, and the guide removed. The procedure was concluded with the standard technique. Feeding was resumed the next day and the patient was sent home. In this patient the needle-knife technique described by Ma et al.1Ma MM Semlacher EA Fedorak RN et al.The buried gastrostomy bumper syndrome: prevention and endoscopic approaches to removal.Gastrointest Endosc. 1995; 41: 505-508Abstract Full Text PDF PubMed Scopus (89) Google Scholar did not succeed in exposing the buried bumper. We think that the needle-knife technique is useful when the bumper has migrated partially or superficially. In cases of deep bumper migration into the gastric wall or impaction into the abdominal wall, the needle-knife method could cause bleeding or ulceration.1Ma MM Semlacher EA Fedorak RN et al.The buried gastrostomy bumper syndrome: prevention and endoscopic approaches to removal.Gastrointest Endosc. 1995; 41: 505-508Abstract Full Text PDF PubMed Scopus (89) Google Scholar The minimal surgical technique that we used allowed a change of gastrostomy tube without opening the peritoneum.