Skip to main content
SpringerLink
Log in

Percutaneous endoscopic gastrostomy tube removal and replacement after “buried bumper syndrome”: the simple way

  • Technique
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Percutaneous endoscopic gastrostomy (PEG) feeding tubes are required for an increasing number of patients with long-term nutritional requirements. “Buried bumper syndrome” (BBS) occurs in 2–6% of PEG placements. In the past, this has been a difficult problem to resolve. The authors aimed to design a safe and simple method of dealing with BBS that can be performed by any endoscopist on a routine endoscopic list with the patient under sedation.

Methods

For 6 years, the authors have used a minimally invasive way to deal with BBS. They have successfully treated 20 BBS patients on a routine endoscopy list with the patient under sedation. The existing PEG is divided 5 cm from the skin. A pair of stent-grasping forceps is inserted via the tube. A snare then is passed via the gastroscope, caught in the stent-grasping forceps, and brought out via the PEG tube. Next, the tube is split as deeply as possible into the PEG exit site, and the snare is closed around the tube. Gentle traction is applied along the endoscope, allowing the internal bumper to concertina and pop through the mucosa. Another PEG can now be placed at a separate site, although the authors have successfully used the same tract.

Results

All the patients were followed up, with no further problems related to BBS.

Conclusions

The authors’ method is a simple way of addressing the difficult BBS problem. It can be used to remove and replace a PEG with a buried bumper on a routine endoscopy list with the patient under sedation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Stem J (1986) Comparison of percutaneous endoscopic gastrostomy with surgical gastrostomy in a community hospital. Am J Gastroenterol 81:1171–1173

    Google Scholar 

  2. Grant JP (1988) Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg 207:598–603

    Article  PubMed  CAS  Google Scholar 

  3. Tanker MS, Scheinfeldt BD, Steerman PH et al (1986) A prospective randomized study comparing surgical gastrostomy and percutaneous endoscopic gastrostomy (abstract). Gastrointest Endosc 32:144

    Google Scholar 

  4. Larson DE, Burton DD, Schroeder KW, Di Magno EP (1987) Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 93:48–52

    PubMed  CAS  Google Scholar 

  5. Hull MA, Rawlings J, Murray FE et al (1993) Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet 341:869–871

    Article  PubMed  CAS  Google Scholar 

  6. Wicks C, Gimson A, Vlavianos P et al (1992) Assessment of percutaneous endoscopic gastrostomy feeding tube as part of an integrated approach to enteral feeding. Gut 33:613–616

    Article  PubMed  CAS  Google Scholar 

  7. Klein S, Heare BR, Soloway RD (1990) The “buried bumper syndrome”: a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol 85:448–451

    PubMed  CAS  Google Scholar 

  8. Finocchiaro C, Galletti R, Rovera G et al (1997) Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition 13:520–523

    Article  PubMed  CAS  Google Scholar 

  9. Ma MM, Semlacher EA, Fedorak RN et al (1995) The buried gastrostomy bumper syndrome: prevention and endoscopic approaches to removal. Gastrointest Endosc 41:505–508

    Article  PubMed  CAS  Google Scholar 

  10. Boyd JW, Delegge MH, Shamburek RD et al (1995) The “buried bumper syndrome”: a new technique for safe, endoscopic percutaneous endoscopic gastrostomy removal. Gastrointest Endosc 41:508–511

    Article  PubMed  CAS  Google Scholar 

  11. Collure DW, Bumpers HL, Hoover EL (1996) A complication of T-fasteners in percutaneous endoscopic gastrostomy placement. Surg Endosc 10:938–939

    Article  PubMed  CAS  Google Scholar 

  12. Sheers R, Chapman S (1998) The buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy. Gut 43:586

    Article  PubMed  CAS  Google Scholar 

  13. Schwaetz HI, Goldberg RI, Barkin JS, Phillips RS, Land A, Hect M (1988) Percutaneous endoscopic gastrostomy feeding tube migration in the abdominal wall. Gastrointest Endosc 35:134

    Article  Google Scholar 

  14. Shallman RW, Norfleet RG, Hardache JM (1988) Percutaneous endoscopic gastrostomy feeding tube migration and impact in the abdominal wall. Gastrointest Endosc 34:367–368

    Article  PubMed  CAS  Google Scholar 

  15. Nelson AM (1988) Percutaneous endoscopic gastrostomy tube migration and erosion into the abdominal wall. Gastrointest Endosc 34:133

    Google Scholar 

  16. Rino Y, Tokunaga M et al (2002) The buried bumper syndrome, an early complication of percutaneous endoscopic gastrostomy. Hepatogastroenterology 49:1183–1184

    PubMed  Google Scholar 

  17. Sasaki T, Fukumori D et al (2003) Percutaneous endoscopic gastrostomy complicated by buried bumper syndrome. Int Surg 88:64–67

    PubMed  Google Scholar 

  18. Vu C (2002) “Buried bumper syndrome”: old problem, new tricks. J Gastroenterol Hepatol 17:1125–1128

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, University Hospital, North Staffordshire NHS Trust, Stoke-on-Trent, UK

    P. Turner & M. Deakin

Authors
  1. P. Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Deakin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Turner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turner, P., Deakin, M. Percutaneous endoscopic gastrostomy tube removal and replacement after “buried bumper syndrome”: the simple way. Surg Endosc 23, 1914–1917 (2009). https://doi.org/10.1007/s00464-008-0299-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-0299-9

Keyword

Search

Navigation