Abstract
Background and study aims Buried bumper syndrome is an infrequent complication of percutaneous endoscopic gastrostomy
(PEG) that can result in tube dysfunction, gastric perforation, bleeding, peritonitis
or death. The aim of this study was to compare the efficacy of different PEG tube
removal methods in the management of buried bumper syndrome in a large retrospective
cohort.
Patients and methods From 2002 to 2013, 82 cases of buried bumper syndrome were identified from the databases
of two endoscopy referral centers. We evaluated the interval between gastrostomy tube
placement and diagnosis of buried bumper syndrome, type of treatment, success rate
and complications. Four methods were analyzed: bougie, grasp, needle-knife and minimally
invasive push method using a papillotome, which were selected based on the depth of
the buried bumper.
Results The buried bumper was cut free with a wire-guided papillotome in 35 patients (42.7 %)
and with a needle-knife in 22 patients (26.8 %). It could be pushed into the stomach
with a dilator without cutting in 10 patients (12.2 %), and was pulled into the stomach
with a grasper in 12 patients (14.6 %). No adverse events (AEs) were registered in
70 cases (85.4 %). Bleeding occurred in 7 patients (31.8 %) after cutting with a needle-knife
papillotome and in 1 patient (8.3 %) after grasping. No bleeding was recorded after
using a standard papillotome or a bougie (P < 0.05). Ten of 22 patients (45.5 %) treated with the needle-knife had a serious
AE and 1 patient died (4.5 %).
Conclusions We recommend that incomplete buried bumpers be removed with a bougie. In cases of
complete buried bumper syndrome, the bumper should be cut with a wire-guided papillotome
and pushed into the stomach.
