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Review
. 2023 Feb 16;15(2):44-55.
doi: 10.4253/wjge.v15.i2.44.

Buried bumper syndrome: A critical analysis of endoscopic release techniques

Alexandra Menni  1 , Georgios Tzikos  1 , George Chatziantoniou  1 , Persefoni Gionga  1 , Theodosios S Papavramidis  1 , Anne Shrewsbury  1 , George Stavrou  1 , Katerina Kotzampassi  2
Affiliations
Review

Buried bumper syndrome: A critical analysis of endoscopic release techniques

Alexandra Menni et al. World J Gastrointest Endosc. .

Abstract

Buried bumper syndrome (BBS) is the situation in which the internal bumper of the gastrostomy tube, due to prolonged compression of the tissues between the external and the internal bumper, migrates from the gastric lumen into the gastric wall or further, into the tract outside the gastric lumen, ending up anywhere between the stomach mucosa and the surface of the skin. This restricts liquid food from entering the stomach, since the internal opening is obstructed by gastric mucosal overgrowth. We performed a comprehensive search of the PubMed literature to retrieve all the case-reports and case-series referring to BBS and its management, after which we focused on the endoscopic techniques for releasing the internal bumper to re-establish the functionality of the tube. From the "push" and the "push and pull T" techniques to the most sophisticated-using high tech instruments, all 10 published techniques have been critically analysed and the pros and cons presented, in an effort to optimize the criteria of choice based on maximum efficacy and safety.

Keywords: Buried bumper syndrome; Endoscopic release techniques; Percutaneous endoscopic gastrostomy; Review.

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Conflict of interest statement

Conflict-of-interest statement: The informed consent was waived from the patients.

Figures

Figure 1
Figure 1
Flow diagram of our Research Strategy.
Figure 2
Figure 2
Description of techniques. A: The “push” Technique: A Savary dilator loaded over the guidewire forced from the outside towards the gastric lumen to release the bumper into the stomach; B and C: The “needle-knife” technique: A pre-cut device was used first and then an alligator forceps pulls the bumper towards the stomach; D-F: The “push-pull T” technique: A T-piece attached to a snare is used to pull the bumper into the stomach.
Figure 3
Figure 3
Description of techniques. A and B: The “new PEG against the old” technique: A new, pull-type, gastrostomy pushed the buried bumper from inside the stomach; C and D: The “snare” technique: A polypectomy snare was used to grasp the catheter inserted from the outside. Traction applied to the snare, leads to dislodging the buried bumper.
Figure 4
Figure 4
Description of techniques. A: A standard papillotome was inserted from the outside under endoscopic control, bent, and drawn back, to perform at least 3 radical cuttings in the mucosa covering the bumper; B: The “balloon dilator” technique: A balloon dilator was endoscopically advanced to meet a guidewire inserted from outside; then was pushed over the guidewire into the tube and inflated to remain impacted. Traction of the balloon allowed the extraction of the bumper.
See this image and copyright information in PMC

References

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