Endoscopy 2019; 51(04): S85
DOI: 10.1055/s-0039-1681419
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: PEG Club B
Georg Thieme Verlag KG Stuttgart · New York

BURIED BUMPER SYNDROME – MANAGEMENT BASED ON ACCURATE STAGING

J Cyrany
1   2nd Department of Internal Medicine – Gastroenterology, Charles University Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
,
R Repak
1   2nd Department of Internal Medicine – Gastroenterology, Charles University Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
,
T Douda
1   2nd Department of Internal Medicine – Gastroenterology, Charles University Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
,
T Fejfar
1   2nd Department of Internal Medicine – Gastroenterology, Charles University Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
,
I Tacheci
1   2nd Department of Internal Medicine – Gastroenterology, Charles University Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
,
S Rejchrt
1   2nd Department of Internal Medicine – Gastroenterology, Charles University Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
,
J Bures
1   2nd Department of Internal Medicine – Gastroenterology, Charles University Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
,
M Kopacova
1   2nd Department of Internal Medicine – Gastroenterology, Charles University Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Aims:

    evaluation of our previously published new classification of buried bumper syndrome (BBS) severity on large retrospective patient cohort.

    Methods:

    single tertiary centre retrospective cohort study.

    Results:

    81 cases of BBS in 72 patients were identified out of 2,024 PEG procedures performed from 1st January 2002 until 31st October 2018 at our endoscopy unit. The cohort consisted of 52 males and 20 females, 12 – 91 years-old (median 65). Excluding 15 cases of PEG introduced elsewhere, incidence of BBS was 3.3% in our unit. Time from insertion until the diagnosis of BBS varied from 2 weeks to more than 6 years (mean 17 months). Dominant symptoms of BBS were as follows: peristomal leakage (19), blocked tube (18), accidental finding during attempt to removal (16), endoscopy for other reasons (10), impossibility of tube rotation and movement (15), gastro-colo-cutaneous fistula (2). Distribution of severity according to the new classification was: Grade 1 (ulcer below the internal bumper and/or marginal overgrowth) 11 cases, Grade 2 (bumper overgrown, but still partially visible) 26 cases (32%), Grade 3 (completely covered bumper inside the stomach) 27 cases (33%), Grade 4 (completely covered bumper outside the stomach) 14 cases, Grade 5 (bumper at the level of skin) 3 cases. Therapeutic outcomes: Grade 1 was treated by simple repositioning and BBS preventive measures were enforced. Grade 2 and 3 were treated by endoscopy with dissection of the overgrowing tissue needed only for Grade 3. Endoscopic dissection using only a papillotome through the cannula was significantly faster (11 ± 9 min) than other dissection procedures (64 ± 47 min, p < 0.001). Endotherapy was ineffective and seriously complicated by peritonitis in one case. Grade 4 needed surgical treatment under general anaesthesia.

    Conclusions:

    Endoscopic therapy of BBS based on the new classification is effective with a low complication rate.

    Reference:

    Cyrany et al. World J Gastroenterol 2016;22:618 – 27.


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