Clinical manifestations and management of buried bumper syndrome in patients with percutaneous endoscopic gastrostomy

BackgroundBuried bumper syndrome has been regarded as an uncommon and late complication after percutaneous endoscopic gastrostomy (PEG) tube insertion. A variety of techniques have been reported to treat this problem, but only a few published cases exist.ObjectiveOur purpose was to present the clinical manifestations and our management of a series of 19 patients with buried bumper syndrome.DesignCase series study.SettingReferral medical centers.PatientsWithin 5 years, 31 episodes of buried bumper syndrome occurred in 10 men and 9 women. The estimated prevalence was 8.8% (19 in 216 PEG procedures during this period).InterventionAll the buried tubes were removed smoothly by external traction and replaced with a new pull-type feeding tube by the pull method or a button or balloon replacement tube after dilation of the old tract.Main Outcome MeasurementsSuccess rate, complication rate.ResultsThe duration between occurrence of buried bumper syndrome and PEG placement ranged from 1 to 50 months, with a median of 18 months. All the episodes were treated successfully except for one, in which reinsertion failed and a new PEG tube was inserted 1 week later. No significant complications occurred.LimitationSmall sample size.ConclusionsBuried bumper syndrome is not that uncommon and can occur soon after insertion of a PEG tube. The buried tube can be safely removed by external traction and in most cases can then be replaced with a pull-type or balloon replacement tube.