PMID- 28670617
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220310
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 5
IP  - 7
DP  - 2017 Jul
TI  - Comparison of removal techniques in the management of buried bumper syndrome: a 
      retrospective cohort study of 82 patients.
PG  - E603-E607
LID - 10.1055/s-0043-106582 [doi]
AB  - 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.
FAU - Mueller-Gerbes, Daniela
AU  - Mueller-Gerbes D
AD  - Kliniken der Stadt Koln gGmbH - Medizinische Klinik/Gastroenterologie, Koln, 
      Germany.
FAU - Hartmann, Bettina
AU  - Hartmann B
AD  - Klinikum Ludwigshafen - Medizinische Klinik C, Ludwighafen, Germany.
FAU - Lima, Julio Pereira
AU  - Lima JP
AD  - Santa Casa Hospital - Gastroenterology, Porto Alegre, Brazil.
FAU - de Lemos Bonotto, Michele
AU  - de Lemos Bonotto M
AD  - Santa Casa Hospital/Porto Alegre University of Health Sciences, Department of 
      Gastroenterology, Porto Alegre, Brazil.
FAU - Merbach, Christoph
AU  - Merbach C
AD  - Klinikum Ludwigshafen - Medizinische Klinik C, Ludwighafen, Germany.
FAU - Dormann, Arno
AU  - Dormann A
AD  - Kliniken der Stadt Koln gGmbH - Medizinische Klinik, Koln, Germany.
FAU - Jakobs, Ralf
AU  - Jakobs R
AD  - Klinikum Ludwigshafen - Medizinische Klinik C, Ludwighafen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20170623
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC5482745
COIS- Competing interests None
EDAT- 2017/07/04 06:00
MHDA- 2017/07/04 06:01
PMCR- 2017/07/01
CRDT- 2017/07/04 06:00
PHST- 2016/10/27 00:00 [received]
PHST- 2017/03/20 00:00 [accepted]
PHST- 2017/07/04 06:00 [entrez]
PHST- 2017/07/04 06:00 [pubmed]
PHST- 2017/07/04 06:01 [medline]
PHST- 2017/07/01 00:00 [pmc-release]
AID - 10.1055/s-0043-106582 [doi]
PST - ppublish
SO  - Endosc Int Open. 2017 Jul;5(7):E603-E607. doi: 10.1055/s-0043-106582. Epub 2017 
      Jun 23.