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

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.

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Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement by an Emergency General Surgery Service: Long-Term Follow-Up is Lacking

The American Surgeon ◽

10.1177/000313481908500704 ◽

2019 ◽

Vol 85 (7) ◽

pp. 323-325

Author(s):

Robert W. DesPain ◽

William J. Parker ◽

Angela T. Kindvall ◽

Eric A. Elster ◽

Elliot M. Jessie ◽

...

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

General Surgery ◽

Tube Placement ◽

Emergency General Surgery ◽

Endoscopic Gastrostomy ◽

Long Term Follow Up ◽

Peg Tube

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Percutaneous Endoscopic Gastrostomy Tube Gone Wrong: Endoscopic Closure to the Rescue

Journal of Digestive Endoscopy ◽

10.1055/s-0041-1739563 ◽

2021 ◽

Vol 12 (03) ◽

pp. 169-171

Author(s):

Jahnvi Dhar ◽

Naveen Kumar ◽

Pankaj Gupta ◽

Rakesh Kochhar ◽

Jayanta Samanta

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Tube Placement ◽

Endoscopic Management ◽

Unusual Complication ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

First Line ◽

Endoscopic Gastrostomy ◽

Endoscopic Closure ◽

Enteral Access ◽

Peg Tube

AbstractPercutaneous endoscopic gastrostomy (PEG) is one of the most commonly performed endoscopic procedures and a first-line treatment for the establishment of enteral access in those with intolerance or contraindication to oral feedings. A small amount of pneumoperitoneum in the immediate postprocedure period is well reported after PEG tube placement. However, pneumoperitoneum resulting from displaced gastric bumper within 24 hours postprocedure is uncommon and rarely reported in the literature. Timely diagnosis and early endoscopic management can help tackle such an unusual complication.

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Early report on percutaneous endoscopic gastrostomy at Owerri, Nigeria

10.25259/ssjep_2_2019 ◽

2021 ◽

Vol 0 ◽

pp. 1-4

Author(s):

Christopher Nonso Ekwunife ◽

Kelechi E. Okonta ◽

Stephen E. Enendu

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Early Report ◽

Cross Sectional Study ◽

Tube Placement ◽

Safe Procedure ◽

Cross Sectional ◽

Endoscopic Gastrostomy ◽

Neurologic Disorders ◽

Superficial Skin ◽

Peg Tube

Objectives: Percutaneous endoscopic gastrostomy (PEG) is a well-established endoscopic procedure that is used predominantly to create enteral access for feeding. Its use has not been widespread in Nigeria despite its efficacy. This study is done to review the early experiences in the use of PEG in Federal Medical Centre, Owerri and Carez Clinic, Owerri. Material and Methods: This is a 4-year retrospective cross-sectional study of patients who had PEG from January 2015 to December 2018. The indications, complications, and outcomes of the procedure were analyzed. Results: A total of 13 patients had pull-type gastrostomy during this period. Six (46.1%) patients had the procedure on account of neurologic disorders, 4 (30.8%) patients had esophageal tumors, while 3 (23.1%) patients had esophageal motility disorders. The overall success rate for PEG tube placement was 100%. The most common complication was superficial skin infection 30.8% (4/13). No mortality was attributable to the procedure. Conclusion: PEG is still not commonly done in our setting, but it is a relatively safe procedure. Physicians should be encouraged to offer it to our teeming patients with neurologic disorders who may benefit from it.

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Analysis of nationwide trends and outcomes of percutaneous endoscopic gastrostomy (PEG) tube placement in hospitalized patients with cancer over a 13-year period

Journal of Investigative Medicine ◽

10.1136/jim-2017-000520 ◽

2017 ◽

Vol 66 (1) ◽

pp. e1-e2

Author(s):

Achuta Kumar Guddati ◽

Gagan Kumar ◽

Iuliana Shapira

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Hospitalized Patients ◽

Tube Placement ◽

Patients With Cancer ◽

Endoscopic Gastrostomy ◽

Peg Tube

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SURGICAL GASTROSTOMY BASED ON ENDOSCOPIC CONCEPTS

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600010013 ◽

2016 ◽

Vol 29 (1) ◽

pp. 50-52

Author(s):

Emmanuel Conrado SOUZA

Keyword(s):

Gastric Wall ◽

Percutaneous Approach ◽

Endoscopic Gastrostomy ◽

Minimal Incision ◽

Left Hypochondrium ◽

Direct View ◽

Anterior Gastric Wall ◽

Enteral Access ◽

Surgical Gastrostomy

Background: Until the early 1980s, Stamm technique was considered standard method to gastrostomy. After description of the endoscopic technique, due to its efficiency and speed, quickly became the method of choice for long-term enteral access. Aim: Describe a technique that combines direct view of the stomach from open surgery with the simplicity and less traumatic endoscopic gastrostomy method. Method: In patient supine under spinal anesthesia the technique stars with small epigastric incision to pull up the stomach. A 3 mm incision in the left hypochondrium is made to pass needle puncture to guidewire passage. The stomach is drilled, guidewire is seizured, connection to catheter and percutaneous approach is made with traction of the stomach to the abdominal wall. Purse suture on the anterior gastric wall is not needed. Results: Twenty-eight patients underwent gastrostomy using endoscopy devices; six had local minor complications without the need for re-intervention; there was no death. Conclusion: The surgical gastrostomy with minimal incision in the stomach to pull off the catheter using endoscopic gastrostomy devices, proved to be safe, easy to perform, less traumatic, quick, simple and elegant.

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A novel device for the endoscopic management of buried bumper syndrome

Endoscopy ◽

10.1055/a-0833-8516 ◽

2019 ◽

Vol 51 (07) ◽

pp. 689-693 ◽

Cited By ~ 4

Author(s):

Pieter Hindryckx ◽

Barbara Dhooghe ◽

Andreas Wannhoff

Keyword(s):

Abdominal Pain ◽

Gastric Mucosa ◽

Percutaneous Endoscopic Gastrostomy ◽

Endoscopic Management ◽

First Line ◽

Off Label ◽

Novel Device ◽

Endoscopic Gastrostomy ◽

Buried Bumper Syndrome ◽

Peg Tube

Abstract Background Buried bumper syndrome (BBS) is a complication of percutaneous endoscopic gastrostomy (PEG) in which the internal bumper is overgrown by the gastric mucosa. Apart from loss of patency of the PEG tube, the buried bumper may evoke symptoms such as abdominal pain or peritubular leakage. While the management of an incompletely buried bumper is fairly straightforward, this is not the case for a completely buried bumper. Different approaches to remove completely buried bumpers have been described, including endoscopic knife- or papillotome-based techniques. However, these devices are used off-label and the procedures can be laborious. Methods The Flamingo device has recently been introduced as the first tool specifically designed to remove a completely buried bumper. Results We describe the technique and our first experience in five patients with a completely (n = 4) or almost completely (n = 1) buried bumper. Fast and save removal of the buried bumper was obtained in all patients. Conclusion We believe that this device has the potential to become the standard first-line tool for the management of completely buried bumpers.

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Acceptability and outcomes of the Percutaneous Endoscopic Gastrostomy (PEG) tube placement- patients' and care givers' perspectives

BMC Gastroenterology ◽

10.1186/1471-230x-6-37 ◽

2006 ◽

Vol 6 (1) ◽

Cited By ~ 24

Author(s):

Muhammad K Anis ◽

Shahab Abid ◽

Wasim Jafri ◽

Zaigham Abbas ◽

Hasnain A Shah ◽

...

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Tube Placement ◽

Endoscopic Gastrostomy ◽

Care Givers ◽

Peg Tube

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Safety and efficacy of percutaneous endoscopic gastrostomy tube placement in patients with malignant peritoneal carcinomatosis induced bowel obstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14012 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14012-e14012

Author(s):

Pankaj G Vashi ◽

Donald Peter Braun ◽

Brenten Popiel ◽

Digant Gupta

Keyword(s):

Peritoneal Carcinomatosis ◽

Bowel Obstruction ◽

Percutaneous Endoscopic Gastrostomy ◽

Insertion Site ◽

Tube Placement ◽

Percutaneous Endoscopic Gastrostomy Tube ◽

Safety And Efficacy ◽

Symptom Resolution ◽

Endoscopic Gastrostomy ◽

Peg Tube

e14012 Background: Percutaneous Endoscopic Gastrostomy (PEG) tube placement in advanced peritoneal carcinomatosis with bowel obstruction is a feasible palliative procedure to help patients with obstructive symptoms. We describe the safety and efficacy of using PEG tube for decompression in patients with large peritoneal masses. Methods: A consecutive case series of 62 patients (Apr-08 to Jun-11) with advanced abdominal carcinomatosis induced bowel obstruction. All patients were extensively treated for their cancer. None of them were surgical candidates due to extensive peritoneal involvement. All patients had symptoms of nausea, vomiting and pain at the time of PEG tube placement. All patients had a 28F (Bard) PEG tube placed for drainage. The primary outcomes of interest were complications and symptom resolution due to PEG tube placement. Frequency of nausea, vomiting and severity of pain was recorded daily in patient charts. Results: 16 were males and 46 females. The mean age was 50.5 years. Most common cancers were ovary, pancreas, colon and stomach. Of 62 patients, 57 patients had expired at the time of this analysis. Of those 57 expired, 49 had PEG tube at the time of death, while 8 had complete resolution of symptoms with PEG tube removed before death. The 5 out of 62 patients who are alive still have the PEG tube for drainage (average 70.4 days). The average duration of PEG tube placement for all patients combined was 70.9 days (range 6-312 days). Relief of nausea, vomiting and pain was observed in 53 (85.5%), 55 (88.7%) and 35 (56.5%) patients respectively. Of a total of 43 patients who had PEG tube placed for >= 30 days, 24 (56%) could continue with their chemotherapy cycles because of symptom resolution. Non life threatening complications of PEG tube placement were observed in 9 (14.5%) patients. 3 had infection at the insertion site, 2 had bleeding and 3 had leaking at the PEG tube site while 1 had aspiration. 6 (9.7%) patients required replacement of the PEG tube due to occlusion. Conclusions: Placement of PEG tube in presence of advanced peritoneal carcinomatosis is safe and effective in relieving obstructive symptoms as well as extending the period of active cancer therapy.

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

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2011/849460 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 1

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.

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