BURIED BUMPER SYNDROME – RISK FACTORS AND TREATMENT

Aims:

The aim of study was to evaluate risk factors for complications of PEG, resp. buried bumper syndrome, and methods of its treatment.

Methods:

The number of patients with buried bumpers syndrom (BBS) were count in Center for PEG Thomayer's Hospital Prague, that takes care of pateints with PEG complications between 2002 and 2018. Buried bumper syndrome (BBS) is the late complication of PEG. Method of choice for treatment is opening of cavity with inner bumper using Flamingo knife introduced through PEG tube and extraction of PEG.

Results:

Since 2002 to 2018 there were introduced 1587 PEGs and PEJs in 1526 patients, in 54 of them there was found buried bumper syndrome (3,4%). Since 2002 to 2016 42 patients with BBS were examined, (31 men, 11 women, aver. age 69,3 y, 2 – 86 y), 35 were succesfully resolved during gastroscopy (8 patients using needle knife or papilotomy devices, the average time for resolving 18 minutes), 7 patients were indicated for surgical treatment. Since end of 2016 we started to use Flamingo knife. SInce 2016 to 201812 patients with BBS were examined (8 men, 4 women, aver. age 72.1 years 35 – 88 years). In 8 patients Flamingo knife was used, the average time for extraction of PEG was 8 minutes (5 – 38 minuites). No surgical treatment was needed in last 2 years.

The main risk factors are incorrect care after PEG, esp. irregular or missing introduction of PEG tube into the stomach (minimally once in the week) and high pressure on inner bumper.

Conclusions:

The buried bumper syndrome is the late complication of percutaneous endoscopic gastrostomy. The main risk factor is incorrect care after PEG tube. The treatment of choice in patients with complete buried bumper syndrome is treatment using Flamingo knife with decreasing of surgical extractions for this diagnose.