scholarly journals Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients

2017 ◽  
Vol 05 (07) ◽  
pp. E603-E607 ◽  
Author(s):  
Daniela Mueller-Gerbes ◽  
Bettina Hartmann ◽  
Julio Lima ◽  
Michele de Lemos Bonotto ◽  
Christoph Merbach ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Treatment Success ◽  
Tube Placement ◽  
Endoscopic Gastrostomy ◽  
Tube Removal ◽  
Tube Dysfunction ◽  
Gastrostomy Tube Placement ◽  
Buried Bumper Syndrome ◽  
Needle Knife ◽  
Peg Tube

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.

Bronchoscope-Guided Percutaneous Endoscopic Gastrostomy Tube Placement by Interventional Pulmonologists: A Feasibility and Safety Study

2018 ◽  
Vol 35 (9) ◽  
pp. 851-857 ◽  
Author(s):  
Erik Folch ◽  
Fayez Kheir ◽  
Amit Mahajan ◽  
Daniel Alape ◽  
Omar Ibrahim ◽  
...  
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Percutaneous Tracheostomy ◽  
Gastrostomy Tube ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Increased Risk ◽  
Tube Removal ◽  
Gastrostomy Tube Placement ◽  
Peg Tube

Background: Percutaneous endoscopic gastrostomy (PEG) tube placement is a procedure frequently done in the intensive care unit. The use of a traditional endoscope can be difficult in cases of esophageal stenosis and theoretically confers an increased risk of infection due to its complex architecture. We describe a technique using the bronchoscope, which allows navigation through stenotic esophageal lesions and also minimizes the risk of endoscopy-associated infections. Methods: Prospective series of patients who had PEG tube placement guided by a bronchoscope. Procedural outcomes including successful placement, duration of the entire procedure, time needed for passage of the bronchoscope from the oropharynx to the major curvature, PEG tube removal rate, and mortality were collected. Procedural adverse events, including infections and long-term PEG-related complications, were recorded. Results: A total of 84 patients underwent bronchoscope-guided PEG tube placement. Percutaneous endoscopic gastrostomy tube insertion was completed successfully in 82 (97.6%) patients. Percutaneous endoscopic gastrostomy tube placement was performed immediately following percutaneous tracheostomy in 82.1%. Thirty-day mortality and 1-year mortality were 11.9% and 31%, respectively. Overall, minor complications occurred in 2.4% of patients, while there were no major complications. No serious infectious complications were identified and no endoscope-associated hospital acquired infections were documented. Conclusions: The use of the bronchoscope can be safely and effectively used for PEG tube placement. The use of bronchoscope rather than a gastroscope has several advantages, which include the ease of navigating through complex aerodigestive disorders such as strictures and fistulas as well as decreased health-care utilization. In addition, it may have a theoretical advantage of minimizing infections related to complex endoscopes.

scholarly journals Inadvertent Percutaneous Endoscopic Gastrostomy Tube Placement through the Transverse Colon to the Stomach Causing Intractable Diarrhea: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
David T. Burke ◽  
Andrew I. Geller ◽  
Alexios G. Carayannopoulos ◽  
Richard Goldstein
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Transverse Colon ◽  
Delayed Diagnosis ◽  
Tube Placement ◽  
Common Mechanism ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Tube Removal ◽  
Peg Tube

Background. Among patients with chronic disease, percutaneous endoscopic gastrostomy (PEG) tubes are a common mechanism to deliver enteral feedings to patients unable to feed by mouth. While several cases in the literature describe difficulties with and complications of the initial placement of the PEG, few studies have documented the effects of a delayed diagnosis of a misplaced tube. Methods. This case study reviews the hospitalization of an 82 year old male with an inadvertent placement of a PEG tube through the transverse colon. Photos of the placement in the stomach as well as those of the follow up colonoscopy, and a recording of the episodes of diarrhea during the hospitalization were made. Results. The records of this patient reveal complaints of gastrointestinal distress and diarrhea immediately after placement of the tube. Placement in the stomach was verified by endoscopy, with discovery of the tube only after a follow up colonoscopy. The tube remained in place after this discovery, and was removed weeks after the diarrhea was unsuccessfully treated with antibiotics. After tube removal, the patient recovered well and was sent home.

scholarly journals Buried Bumper Syndrome Revisited: A Rare but Potentially Fatal Complication of PEG Tube Placement

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Saptarshi Biswas ◽  
Sujana Dontukurthy ◽  
Mathew G. Rosenzweig ◽  
Ravi Kothuru ◽  
Sunil Abrol
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Gastric Wall ◽  
Late Complications ◽  
Tube Placement ◽  
Endoscopic Gastrostomy ◽  
Enteral Access ◽  
Delayed Complications ◽  
Buried Bumper Syndrome ◽  
Peg Tube

Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.

Meningitis Due to Enterobacter aerogenes Subsequent to Resection of Acoustic Neuroma and Percutaneous Endoscopic Gastrostomy Tube Placement: A Rare Nosocomial Event

2003 ◽  
Vol 24 (10) ◽  
pp. 780-782 ◽  
Author(s):  
David M. Poetker ◽  
Charles E. Edmiston ◽  
Michelle M. Smith ◽  
Glenn A. Meyer ◽  
Phillip A. Wackym
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Acoustic Neuroma ◽  
Enterobacter Aerogenes ◽  
Intervention Strategies ◽  
Gastrostomy Tube ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Gastrostomy Tube Placement ◽  
Peg Tube

AbstractWe present a case of meningitis after percutaneous endoscopic gastrostomy (PEG) tube placement subsequent to acoustic neuroma resection and cranioplasty. Four days following PEG tube placement the patient developed Enterobacter aerogenes meningitis, requiring explantation of infected cranioplasty material. His condition subsequently improved. Etiology and future intervention strategies are discussed (Infect Control Hosp Epidemiol 2003;24:780-782).

scholarly journals Metastatic Implantation of Head and Neck Squamous Cell Cancer at PEG Tube Site Exit— An Unusual Relapse Site: A Case Report and Review of Literature

2011 ◽  
Vol 2 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Vijay Palwe ◽  
Kaustav Talpatra ◽  
Umesh Mahantshetty ◽  
Seethalaxmi Viswanathan
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Neck Cancer ◽  
Squamous Cell ◽  
Gastrostomy Tube ◽  
Tube Placement ◽  
Endoscopic Gastrostomy ◽  
Gastrostomy Tube Placement ◽  
Peg Tube

ABSTRACT Background The placement of percutaneous endoscopic gastrostomy (PEG) tubes is a common procedure in patients with head and neck cancer who require adequate nutrition because of the inability to swallow before or after surgery and adjuvant therapies. A potential complication of percutaneous endoscopic gastrostomy tubes is the metastatic spread from the original head and neck tumor to the gastrostomy site. Methods This is a case of a 55-year-old male with a (cT4N3M0) stage IV squamous cell carcinoma of the oropharynx who underwent percutaneous endoscopic gastrostomy tube placement prior to commencement of definitive chemoradiation therapy and 7 months thereafter developed metastatic spread to the gastrostomy site. Tumor was treated with radiation therapy. A review of the published literature regarding the subject is done. The pull-through method of gastrostomy tube placement had been used in our patient as well as in the majority of the other cases reviewed in the literature. Conclusions There is a small but definite risk for tumor implantation in the gastrostomy site when using the pull technique in patients with active head and neck cancer. The direct implantation of tumor through instrumentation is the most likely explanation for metastasis; however, hematogenous seeding is also a possibility. Careful assessment of the oropharynx and hypopharynx before PEG tube placement and the use of alternative techniques for enteral access in patients with untreated or residual malignancy are recommended to minimize this risk.

scholarly journals Percutaneous Endoscopic Gastrostomy Tube Placement in COVID-19 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Hemant Goyal ◽  
Aman Ali ◽  
Pardeep Bansal
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Enteral Feeding ◽  
Multidisciplinary Approach ◽  
Discharge Planning ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Endoscopic Gastrostomy ◽  
The World ◽  
Gastrostomy Tube Placement ◽  
Peg Tube

Intensive care units (ICU) around the world are overburdened with COVID-19 patients with ventilator-dependent chronic respiratory failure (VDRF). Gastroenterology evaluations are being made to address the provision of chronic enteral feeding with the help of percutaneous endoscopic gastrostomy (PEG) placements in these patients. The placement of the PEG tube along with tracheostomy in patients with COVID-19 and prolonged VDRF may expedite discharge planning and increase the availability of ICU beds for other patients. Herein, we describe a multidisciplinary approach of PEG tube placements for patients with SARS-CoV-2-induced chronic VDRF for continued enteral feeding to avoid complications and decrease the length of stay.

scholarly journals GP.03 Outcomes after gastrostomy tube placement in patients with acute stroke: A 10-year population-based study using the Ontario Stroke Registry

2017 ◽  
Vol 44 (S2) ◽  
pp. S7-S7
Author(s):  
R Joundi ◽  
G Saposnik ◽  
R Martino ◽  
J Fang ◽  
V Giannakeas ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Population Based ◽  
Tube Placement ◽  
Term Care ◽  
Stroke Registry ◽  
Endoscopic Gastrostomy ◽  
Gastrostomy Tube Placement ◽  
Poor Outcomes ◽  
Peg Tube

Background: Dysphagia is a common and devastating complication after acute stroke. Percutaneous endoscopic gastrostomy (PEG) tubes are often placed for persistent dysphagia. However, little is known regarding outcomes after PEG tube placement. Methods: We used a 10-year Ontario Stroke Registry to shed light on the clinical outcomes of patients with PEG tube insertion after ischemic stroke or intracranial hemorrhage compared to patients with only NG tubes, including rate of pneumonia, disability, and mortality. Results: Using propensity score matching, 1,793 patients were successfully matched and had similar baseline characteristics. Compared with NG, patients with PEG had a higher rate of pneumonia (32.6% vs. 20.6%; RR 1.59), higher disability at discharge (modified Rankin Scale Score 3-5; 74.0% vs. 65.4%; RR 1.13), and higher rate of long-term care placement (27.1% vs. 9.3%; RR 2.9). >From stroke onset, there was a lower rate of death in patients with PEG compared to NG at 30 days (15.3% vs. 34.3%; RR 0.45) but no difference at 2 years (52.8% vs. 53.5%; RR 0.99, p=0.71). *All significant p <0.0001. Conclusions: In conclusion, PEG tube placement after stroke may prolong survival in patients with poor outcomes. Our study provides a framework for discussions between physicians, patients, and families with regards to expected prognosis after PEG tube placement.

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