The Cambridge experience with buried bumpers
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Read the article on jpedsurg.org ↗Article · Nov 2018 · 1 min read
In brief
In brief
Cambridge University Hospital reports a novel endoscopic technique for removing buried bumper syndrome in pediatric PEG tubes, successfully treating 12 of 15 cases without laparotomy. The retrograde snare method allows same-day discharge and avoids major surgery for this common gastrostomy complication.
Written by the GCMD Library team from the article.
Aim
Buried Bumper (BB) is a complication of percutaneous endoscopic gastrostomy (PEG) that leads to tube dysfunction and major morbidity. Although many techniques have been described to manage BB, none are universally adopted, and laparotomy remains the mainstay. We introduce a novel endoscopic technique in paediatric surgery that avoids laparotomy.
Methods
A retrospective review of medical records of patients who presented with BB to Cambridge University Hospital, UK, between January 2012 and June 2018 was done. Data collected included: demographics, tube size and type, interval between insertion and diagnosis of BB, hospital stay, technique used, and postoperative complications. The technique involved using an endoscopic snare passed from inside the stomach lumen through the PEG lumen to the outside, guided if required by a stiff nylon thread if no part of the PEG was visible, grasping the PEG tube externally after cutting it short, followed by a retrograde pull to remove the buried tube via the mouth.
Main results
Fifteen BBs were found in ten patients. Median patient age was 5.25 years (1.2–16.6). Median time between gastrostomy insertion and diagnosis of BB was 9 months (1–32). Twelve BBs were removed endoscopically with no postoperative complications. Patients had a replacement inserted through the original track and were discharged within 24 h. Two underwent laparotomies performed by surgeons unfamiliar with endoscopic technique, and one was converted to laparotomy owing to inability to transverse an encrusted and closed PEG tube lumen.
Conclusion
Endoscopic retrograde BB removal is a safe, easy, and quick technique with minimal complications. We strongly advocate widespread adoption of the technique before considering a laparotomy.
Level of evidence
Treatment study: Level IV.