Two Cases of Early Onset Acute Buried Bumper Syndrome after Percutaneous Endoscopic Gastrostomy

Buried bumper syndrome (BBS) is an unusual complication of percutaneous endoscopic gastrostomy (PEG) tube placement, typically occurring 3-6 months thereafter. Few documented cases exist of BBS occurring within 14 days of PEG tube insertion (termed early onset BBS). Information regarding the clinical features and appropriate management of early onset BBS is limited. Herein we report our experience of two cases of early onset BBS successfully treated endoscopically, together with the literature review.

Acute buried bumper syndrome: An endoscopic buried bumper syndrome:approach.

Acute buried bumper syndrome is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. If not recognized and treated appropriately, it can lead to serious complications including death. We report a case of an acute buried bumper syndrome, successfully managed with PEG tube repositioning through the original tract, without the need of replacement.

A Case of Buried Bumper Syndrome Complicated by Abdominal Wall Abscess in an Elderly Patient

The percutaneous endoscopic gastrostomy is used for nutritional support in patients requiring prolonged tubal feeding. Unfortunately, numerous complications, such as infection, stomal leak, fever, local pain, ileus and tube occlusion, have been reported since its introduction. The buried bumper syndrome is a rare but well-recognized long-term complication. The tight anchorage between the internal and external bumpers leads to gastric mucosal erosion and embedding of the internal bumper into the gastric wall, obstructing feeding. Our case involves an elderly patient with a buried bumper syndrome complicated by an abdominal wall abscess. A similar case has not been reported in Korea before. This article reports our findings and management with a review of the literature.

Two cases of buried bumper syndrome after percutaneous endoscopic gastrostomy / 대한내과학회지

Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support in patients who require prolonged tube feeding. However, numerous complications have been reported since its introduction. Buried bumper syndrome is an uncommon, but well-documented, complication of PEG placement. The condition often results from excessive pressure exerted on the gastric mucosa by the tight anchorage between the internal and external bumpers. This leads to mucosal erosion and embedding of the internal bumper in the gastric wall, which obstructs feeding. We report two cases of buried bumper syndrome: one was corrected using the push technique and the other was removed surgically.

A Case of Successful Closure using Endoscopic Hemostatic Clips with a Detachable Snare and Fibrin Glue Injection for a Gastro-Cutaneous Fistula following Buried Bumper Syndrome / 대한소화기내시경학회지

The buried bumper syndrome is a well-recognized long-term complication of a percutaneous endoscopic gastrostomy (PEG). Most of the buried bumpers are removed by making an external incision over the PEG site under local anesthesia or during a laparotomy. Recently, endoscopic removal is usually attempted. While the removal of the PEG tube is usually followed by spontaneous closure of the gastrostomy tract, a non-healing gastro-cutaneous fistula is difficult to manage. The fistula is generally treated with bowel rest and total parenteral nutritional support, suppression of gastric acid secretion, and occasionally, surgical exploration and wedge excision of the fistula site are performed. However, in debilitated patients, surgical management is accompanied with high morbidity and mortality. Recently, the use of nonsurgical alternative methods, such as endoscopic therapy using tissue adhesives or hemostatic clips, has emerged with recent advances in endoscopic technology. We report a case of successful closure using endoscopic hemostatic clips with a detachable snare and fibrin glue injection for a gastro-cutaneous fistula following buried bumper syndrome.

A Case of Buried Bumper Syndrome; A case report

Percutaneous endoscopic gastrostomy is used for long-term nutritional support to the patients who cannot maintain the adequate oral intake and can be performed with relatively few complications. Among the complications, migration of the internal bumper into the abdominal wall, so called "buried bumper syndrome" has been described more recently. We decribed a case of buried bumper syndrome in stroke patient with percutaneous endoscopic gastrostomy. He experienced peritubular leakage, resistance of tubal feeding, and abdominal pain which were developed 4 weeks after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen coud not be found. The gastrostomy tube was replaced with careful manual traction and replaced to new one with endoscopic technique. No complication was occurred and the function of tube has been well preserved.

A Case of Buried Bumper Syndrome Replaced by Endoscopic Management / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support to the patients who cannot maintain the adequate oral intake. Compared with operative gastrostomy, PEG is a safe, rapid, and less expensive technique. Among several complications, buried bumper syndrome is a late complication in which internal bumper erodes into the gastric wall or migrates into the abdominal wall due to improper compression to the gastric wall. We here report a patient with peritubular leakage, resistance of tube feeding, and abdominal pain which were developed 13 months after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen could not be found. The gastrostomy tube was replaced successfully to new one with single procedure endoscopic technique. No complication was occurred and the function of tube has been well preserved.

A Case of Buried Bumper Syndrome / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy is used for long-term nutritional support and can be performed with relatively few complications. Among the major and minor complications, migration and erosion of the internal bumper into or through the abdominal wall, so called buried bumper syndrome has been described more recently. We describe a patient in whom internal bumper eroded into stomach wall and was completely covered by gastric epithelium 45 days after gastrostomy placement. The gastrostomy tube itself was patent, and the end still protruded into the lumen of the stomach. But, endoscopy was failed to remove the gastrostomy tube and surgical exploration was required in our case. We experienced a case of buried bumper syndrome after percutaneous endoscopic gastrostomy and report with a review of literatures.