Multicenter cohort study of patients with buried bumper syndrome treated endoscopically with a novel, dedicated device

Published on Nov 19, 2020in Gastrointestinal Endoscopy6.89
· DOI :10.1016/J.GIE.2020.11.009
Deborah Costa2
Estimated H-index: 2
(UCL: University College London),
Edward J. Despott12
Estimated H-index: 12
(UCL: University College London)
+ 17 AuthorsAlberto Murino8
Estimated H-index: 8
(UCL: University College London)
Background and Aims Buried bumper syndrome (BBS) is a rare adverse event of percutaneous endoscopic gastrostomy (PEG) placement in which the internal bumper migrates through the stomal tract to become embedded within the gastric wall. Excessive tension between the internal and external bumpers, causing ischemic necrosis of the gastric wall, is believed to be the main etiologic factor. Several techniques for endoscopic management of BBS have been described using off-label devices. The Flamingo set is a novel, sphincterotome-like device specifically designed for BBS management. We aimed to evaluate the effectiveness of the Flamingo device in a large, homogeneous cohort of patients with BBS. Methods A guidewire was inserted through the external access of the PEG tube into the gastric lumen. The Flamingo device was then introduced into the stomach over the guidewire. This dedicated tool can be flexed by 180 degrees, exposing a sphincterotome-like cutting wire, which is used to incise the overgrown tissue until the PEG bumper is exposed. A retrospective, international, multicenter cohort study was conducted on 54 patients between December 2016 and February 2019. Results The buried bumper was successfully removed in 53 of 55 procedures (96.4%). The median time for the endoscopic removal of the buried bumper was 22 minutes (range, 5-60). Periprocedural endoscopic adverse events occurred in 7 procedures (12.7%) and were successfully managed endoscopically. A median follow-up of 150 days (range, 33-593) was performed in 29 patients (52.7%), during which no significant adverse events occurred. Conclusions Through our experience, we found this dedicated novel device to be safe, quick, and effective for minimally invasive, endoscopic management of BBS.
#1Nikolaos Lazaridis (UCL: University College London)H-Index: 3
#2Alberto Murino (UCL: University College London)H-Index: 8
Last. Edward J. Despott (UCL: University College London)H-Index: 12
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1 CitationsSource
#1Jiří Cyrany (Charles University in Prague)H-Index: 5
#2Rudolf Repák (Charles University in Prague)H-Index: 7
Last. Marcela Kopacova (Charles University in Prague)H-Index: 21
view all 8 authors...
#1Pieter HindryckxH-Index: 23
#2Barbara DhoogheH-Index: 9
Last. Andreas WannhoffH-Index: 12
view all 3 authors...
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 des...
5 CitationsSource
#1Jose Bennell (Royal Free London NHS Foundation Trust)H-Index: 3
Buried Bumper Syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG) tubes. Advice in prevention guidelines differ, but locally agreed protocols can be agreed using the existing evidence. Consideration needs to be given as to how tightly a PEG is clipped after insertion to prevent gastric leakage, and how long after the procedure should it be loosened to prevent BBS. The distance a PEG tube is advanced and whether it should be rotated is also important in order to pre...
2 CitationsSource
#1Laura E Wolpert (Peterborough City Hospital)H-Index: 2
#2Dominic M. Summers (Peterborough City Hospital)H-Index: 11
Last. Andrew Tsang (Peterborough City Hospital)H-Index: 3
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Novel endoscopic management of buried bumper syndrome in percutaneous endoscopic gastrostomy: The Olympus HookKnife
6 CitationsSource
#2Bettina HartmannH-Index: 2
Last. Ralf JakobsH-Index: 30
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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 endo...
14 CitationsSource
#1Emily Clarke (Derriford Hospital)H-Index: 1
#2Narrie Pitts (Derriford Hospital)H-Index: 2
Last. Stephen Lewis (Derriford Hospital)H-Index: 19
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Summary Background & aims Morbidity after 30 days and morbidity after 1 year from gastrostomy placement is poorly characterised as patients are discharged into the community. We prospectively recorded morbidity and mortality associated with gastrostomy placement over a five year period. Patients and methods Community dietitians regularly reviewed all patients with a gastrostomy after hospital discharge, prospectively recording morbidity and mortality between 2008 and 2012. In addition hospital d...
10 CitationsSource
#1Ozgur Kara (Hacettepe University)H-Index: 5
#1Ozgur Kara (Hacettepe University)H-Index: 12
Last. Meltem Halil (Hacettepe University)H-Index: 24
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Background: Percutaneous endoscopic gastrostomy (PEG) tube placement is a common procedure performed to provide a route for enteral feeding. We aimed to examine the survival after PEG in older adults with neurologic disease and to demonstrate the factors associated with mortality. Methods: We analyzed the data of 500 patients who underwent PEG placement between 2005 and 2015 at a university hospital. The data included age, sex, follow-up duration, comorbidities, medications, indications for PEG,...
6 CitationsSource
#1Jiri CyranyH-Index: 6
#2Stanislav RejchrtH-Index: 22
Last. Jan BuresH-Index: 28
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Percutaneous endoscopic gastrostomy (PEG) is a widely used method of nutrition delivery for patients with long-term insufficiency of oral intake. The PEG complication rate varies from 0.4% to 22.5% of cases, with minor complications being three times more frequent. Buried bumper syndrome (BBS) is a severe complication of this method, in which the internal fixation device migrates alongside the tract of the stoma outside the stomach. Excessive compression of tissue between the external and intern...
53 CitationsSource
Hintergrund Das Buried-bumper-Syndrom (BBS) ist eine seltene, aber schwere Komplikation der perkutan-endoskopischen Gastrostomie (PEG) und begleitet diese in ca. 0,9 bis >8 %. Bislang existiert keine klinisch/endoskopische Einteilung, die das Ausmas der BBS-Migration in Relation zur Therapie und dem dadurch bedingten Risiko, insbesondere der Perforation setzt.
11 CitationsSource
Cited By1
Background Percutaneousendoscopic gastrostomy is a commonly used endoscopic technique where a tube isplaced through the abdominal wall mainly to administer fluids, drugs and/orenteral nutrition. Several placement techniques are described in the literaturewith the ‘pull’ technique (Ponsky-Gardener) as the most popular one.Independent of the method used, placement includes a ‘blind’ perforation of thestomach through a small acute surgical abdominal wound. It is a generally safetechnique with only ...