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. 2023 Dec 11;9(1):213.
doi: 10.1186/s40792-023-01785-7.

Buried bumper syndrome in percutaneous endoscopic gastrostomy with a jejunal extension tube in patients undergoing levodopa-carbidopa intestinal gel treatment

Masatoshi Nakagawa  1 , Noboru Inoue  2 , Shuhei Takise  2 , Masashi Takayanagi  2 , Tsukasa Kubo  2 , Hiroto Muroi  2 , Masanobu Nakajima  2 , Shinji Morita  2 , Takatoshi Nakamura  3 , Kazuyuki Kojima  2
Affiliations

Buried bumper syndrome in percutaneous endoscopic gastrostomy with a jejunal extension tube in patients undergoing levodopa-carbidopa intestinal gel treatment

Masatoshi Nakagawa et al. Surg Case Rep. .

Abstract

Background: Levodopa-carbidopa intestinal gel (LCIG) treatment is an effective Parkinson's disease (PD) treatment that requires percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG-J). Buried bumper syndrome (BBS) is an uncommon but significant complication of PEG-J for LCIG. Case presentation A 71-year-old man had been undergoing LCIG therapy for PD since a PEG-J was implemented at our department two years previously. He presented with appetite loss. Computed tomography showed that the gastrostomy bumper was buried in the gastric wall. The patient was surgically treated with the simultaneous removal and replacement of PEG-J. Postoperative gastrocutaneous fistula occurred, which was conservatively treated.

Conclusions: Notably, patients and medical staff should be aware that patients with PD on LCIG treatment have a high risk of BBS in PEG-J and that there might be some patients with latent BBS. When simultaneous removal and replacement surgery is performed, establishing a new route at the stomach and abdominal wall is recommended.

Keywords: Buried bumper syndrome; Levodopa–carbidopa intestinal gel; Percutaneous endoscopic gastrostomy with a jejunal extension tube.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative imaging findings. a CT revealed an internal bumper of PEG-J buried in the gastric wall. b EGD showed a complete BBS of PEG-J. PEG-J, percutaneous endoscopic gastrostomy with a jejunal extension tube; BBS, buried bumper syndrome; EGD esophagogastroduodenoscopy; CT computed tomography
Fig. 2
Fig. 2
Surgical findings. a The internal bumper was buried entirely in a resected fistula. b Intraoperative fluoroscopy confirmed new PEG-J placed in the proximal jejunum. c A surgical schema showing skin incision and PEG-J site. d Intraoperative EGD confirming the internal bumper inside the stomach and no gap around the tube. PEG-J, percutaneous endoscopic gastrostomy with a jejunal extension tube; EGD esophagogastroduodenoscopy
Fig. 3
Fig. 3
Postoperative findings. a Wound dehiscence occurred, and food residue exuded from a gastrocutaneous fistula. b CT showing a gastrocutaneous fistula (red arrows). There was no sign of free air or ascites. c EGD revealed a gap around the PEG-J. d A follow-up EGD showed the disappearance of the gap around the PEG-J.PEG-J, percutaneous endoscopic gastrostomy with a jejunal extension tube; EGD esophagogastroduodenoscopy; CT computed tomography
See this image and copyright information in PMC

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