Buried bumper syndrome (BBS) is a rare yet significant complication following percutaneous
endoscopic gastrostomy (PEG) that necessitates prompt intervention following diagnosis
[1]
[2]. There are many methods available for treating BBS, each requiring distinct devices,
some of which may need to be specifically dedicated, along with complex endoscopic
techniques to guarantee effective treatment [3]. Therefore, we explored the use of commonly available devices, namely hot biopsy
forceps and a polypectomy snare, to successfully and efficiently manage a case of
BBS ([Video 1]).
Release of buried bumper using hot biopsy forceps and polypectomy snare, and replacement
of percutaneous endoscopic gastrostomy device and jejunal tube.Video 1
A 63-year-old patient with a history of long-term enteral nutrition via a PEG–jejunum
(PEG-J) tube was admitted to our hospital with symptoms of redness and swelling around
the insertion site, as well as difficulty in pushing the PEG tube into the stomach.
Following an endoscopic examination, the patient was diagnosed with complete BBS.
We used the position of the jejunal tube to locate the center of the buried bumper
([Fig. 1]
a). Using hot biopsy forceps, we grasped the granulation tissue covering the bumper
and progressively removed it by alternating between coagulation and cutting modes
([Fig. 1]
b). It was not necessary to remove all the granulation tissue covering the entire bumper.
Instead, each time granulation tissue was grasped, the hot biopsy forceps were positioned
as close as possible to the base of the jejunal tube, which was also the center of
the bumper, so that exposure of only a small portion of the central hard structure
of the bumper was sufficient to allow proceeding to the next step ([Fig. 1]
c). Subsequently, biopsy forceps were introduced through the PEG tube from the external
side to grasp a polypectomy snare, which was then drawn through the PEG tube. Following
that, the push–pull T technique [4] was employed to pull the buried bumper into the gastric lumen and extract it through
the mouth ([Fig. 2]). A new PEG tube was inserted through the original gastrostomy site, and a replacement
jejunal tube was simultaneously placed. Jejunal feeding could commence immediately
following the procedure. On the 3rd postoperative day, a follow-up endoscopy demonstrated
satisfactory healing at the gastric stoma site ([Fig. 3]).
Fig. 1 Endoscopic release and replacement of buried bumper in a percutaneous gastrostomy.
a The jejunal tube enabled identification of the bumper’s center. b The granulation tissue over the bumper’s center was removed with hot biopsy forceps.
c Part of the central hard structure of the bumper (arrow) was exposed.
Fig. 2 The push–pull T technique was employed to easily release the buried bumper.
Fig. 3 The gastric stoma site showed good healing on the 3rd postoperative day.
This method does not require dedicated devices or complex endoscopic techniques, making
it an effective, economical, and safe approach for treating BBS.
Endoscopy_UCTN_Code_TTT_1AO_2AK
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