Buried bumper syndrome

Last updated
Buried bumper syndrome
Specialty Gastroenterology
Symptoms Asymptomatic, tube dysfunction
Complications Bleeding, infection, abscess, peritonitis
Usual onset>1 year after G tube placement
CausesExcessive tightening of the external bumper
Risk factors Obesity, weight gain, malnutrition, corticosteroid therapy, and poor wound healing.
Diagnostic method Upper endoscopy
TreatmentGastrostomy tube removal
Frequency0.3–2.4% of people with a G-tube

Buried bumper syndrome (BBS) is a condition that affects feeding tubes placed into the stomach (gastrostomy tubes) through the abdominal wall. Gastrostomy tubes include an internal bumper, which secures the inner portion of the tube inside the stomach, and external bumper, which secures the outer portion of the tube and opposes the abdomen. Buried bumper syndrome occurs when the internal bumper of a gastrostomy tube erodes into the wall of the stomach. The internal bumper may become entirely buried within the fistulous tract. The main causative factor is excessive tightening of the external bumper, leading to increased pressure of the internal bumper on the wall of the stomach. Additional risk factors include: obesity, weight gain, malnutrition, corticosteroid therapy, and poor wound healing.

Contents

Buried bumper syndrome may be entirely asymptomatic, though tube dysfunction is common. The gastrostomy tube may leak around the entry site, or it may become difficult to infuse feeds, fluids or medications. Less often, bleeding, infection, abscess or peritonitis may occur. Diagnosis is achieved most often with upper endoscopy. Computed tomography imaging may also confirm the diagnosis. Treatment consists of removal of the gastrostomy tube, either via simple external traction or endoscopic removal. Surgery is rarely necessary.

Signs and symptoms

Buried bumper syndrome may be asymptomatic, especially early in the course. Dysfunction of the tube occurs commonly, including leakage around the insertion site, inability to administer feedings or fluids, or need for more pressure when giving feeds. [1] Buried bumper syndrome may cause abdominal pain or swelling (erythema) at the site of insertion of the PEG tube. Less commonly, buried bumper syndrome may also be complicated by acute infectious illness (sepsis), abscess formation, gastrointestinal bleeding or peritonitis. [2] [3] In some cases, the internal bumper may be felt by palpating the abdomen. [2] Inspection of the tube typically reveals an inability to easily rotate the tube. [2]

Cause

Buried bumper syndrome occurs when this internal bumper erodes into the wall of the stomach, sometimes becoming entirely buried within the wall of the stomach. Buried bumper syndrome tends to be a late complication of gastrostomy tube placement, but can rarely occur as early as 1 to 3 weeks after tube placement. [4] [5] Most cases occur more than 1 year after initial placement of the PEG tube. [2]

Excessive tightening of the external bumper is the primary risk factor for buried bumper syndrome. Maintaining the external bumper in a loose position may help prevent buried bumper syndrome. [6] Additional risk factors include obesity, medications, poor wound healing, malnutrition, etc. Feeding tubes with soft balloon internal bumpers are less likely to cause buried bumper syndrome, compared with more firm or stiff polyurethane internal bumpers.[ citation needed ]

Diagnosis

Buried bumper syndrome may be suspected based on features consistent with this disorder. The diagnosis is confirmed either endoscopically (via upper endoscopy) or with computed tomography. [7] Upper endoscopy may reveal overgrowth of stomach tissue over the internal bumper (incomplete buried bumper syndrome). [1] If the bumper has eroded deep into the gastric mucosa, it may not be visualized during endoscopic evaluation (complete buried bumper syndrome). [1]

Prevention

Prevention consists of maintaining a space of 1–2 cm between the external bumper of the gastrostomy tube and the abdominal wall, which avoids excess pressure of the internal bumper onto the stomach wall. Mobilizing and rotating the tube may prevent mucosal overgrowth and aid in avoiding buried bumper syndrome. Severe cases may lead to death.[ citation needed ]

Treatment

Treatment of buried bumper syndrome consists of removal of the gastrostomy tube. For mild cases with externally removable tubes, simple external traction may be used to remove the tube. Several different approaches may be utilized, including endoscopy. [8] [9] If endoscopic removal is pursued, a new feeding tube may be placed during the same procedure. [10] Where endoscopic removal is not possible, surgery may be necessary (laparoscopic or laparotomy).

Epidemiology

Buried bumper syndrome occurs in 0.3–2.4% of patients. Malnutrition, malignancy, chemoradiation, and corticosteroid therapy are additional risk factors.[ citation needed ]

History

In 1980, the first percutaneous endoscopic gastrostomy (PEG) tube was reported, as an alternative to an open surgical placement of feeding tubes. The first cases of buried bumper syndrome were reported in 1988 and 1989. [11] The term "buried bumper syndrome" was first used in 1990. [8]

See also

Related Research Articles

<span class="mw-page-title-main">Gastroenterology</span> Branch of medicine focused on the digestive system and its disorders

Gastroenterology is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometimes referred to as the GI tract, which includes the esophagus, stomach, small intestine and large intestine as well as the accessory organs of digestion which include the pancreas, gallbladder, and liver. The digestive system functions to move material through the GI tract via peristalsis, break down that material via digestion, absorb nutrients for use throughout the body, and remove waste from the body via defecation. Physicians who specialize in the medical specialty of gastroenterology are called gastroenterologists or sometimes GI doctors. Some of the most common conditions managed by gastroenterologists include gastroesophageal reflux disease, gastrointestinal bleeding, irritable bowel syndrome, inflammatory bowel disease (IBD) which includes Crohn's disease and ulcerative colitis, peptic ulcer disease, gallbladder and biliary tract disease, hepatitis, pancreatitis, colitis, colon polyps and cancer, nutritional problems, and many more.

<span class="mw-page-title-main">Pancreatitis</span> Inflammation of the pancreas

Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. There are two main types: acute pancreatitis, and chronic pancreatitis.

<span class="mw-page-title-main">Endoscopy</span> Procedure used in medicine to look inside the body

An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ.

<span class="mw-page-title-main">Feeding tube</span> Medical device used to provide nutrition to people

A feeding tube is a medical device used to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units. They are classified by the site of insertion and intended use.

<span class="mw-page-title-main">Esophagogastroduodenoscopy</span> Diagnostic endoscopic procedure

Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure. However, a sore throat is common.

<span class="mw-page-title-main">Mallory–Weiss syndrome</span> Bleeding from a laceration in the mucosa at the junction of the stomach and esophagus

Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from a laceration in the mucosa at the junction of the stomach and esophagus. This is usually caused by severe vomiting because of alcoholism or bulimia, but can be caused by any condition which causes violent vomiting and retching such as food poisoning. The syndrome presents with hematemesis. The laceration is sometimes referred to as a Mallory–Weiss tear.

<span class="mw-page-title-main">Percutaneous endoscopic gastrostomy</span> Feeding tube going into the stomach through the abdominal wall

Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. This provides enteral nutrition despite bypassing the mouth; enteral nutrition is generally preferable to parenteral nutrition. The PEG procedure is an alternative to open surgical gastrostomy insertion, and does not require a general anesthetic; mild sedation is typically used. PEG tubes may also be extended into the small intestine by passing a jejunal extension tube through the PEG tube and into the jejunum via the pylorus.

<span class="mw-page-title-main">Gastrostomy</span> Surgical procedure creating opening in stomach

A gastrostomy is the creation of an artificial external opening into the stomach for nutritional support or gastric decompression. Typically this would include an incision in the patient's epigastrium as part of a formal operation. When originally devised over a century ago the procedure was completed through open surgery using the Stamm technique. It can be performed through surgical approach, percutaneous approach by interventional radiology, percutaneous endoscopic gastrostomy (PEG) or percutaneous ultrasound gastrostomy (PUG).

<span class="mw-page-title-main">Gastric antral vascular ectasia</span> Medical condition of the stomach

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<span class="mw-page-title-main">Endoscopic foreign body retrieval</span>

Endoscopic foreign body retrieval refers to the removal of ingested objects from the esophagus, stomach and duodenum by endoscopic techniques. It does not involve surgery, but rather encompasses a variety of techniques employed through the gastroscope for grasping foreign bodies, manipulating them, and removing them while protecting the esophagus and trachea. It is of particular importance with children, people with mental illness, and prison inmates as these groups have a high rate of foreign body ingestion.

<span class="mw-page-title-main">Double-balloon enteroscopy</span>

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<span class="mw-page-title-main">Ascending cholangitis</span> Medical condition

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Postcholecystectomy syndrome (PCS) describes the presence of abdominal symptoms after a cholecystectomy.

<span class="mw-page-title-main">Colonic polypectomy</span> Removal of colorectal polyps to prevent them turning cancerous

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<span class="mw-page-title-main">Percutaneous transhepatic cholangiography</span> Medical imaging of the biliary tract

Percutaneous transhepatic cholangiography, percutaneous hepatic cholangiogram (PTHC) is a radiological technique used to visualize the anatomy of the biliary tract. A contrast medium is injected into a bile duct in the liver, after which X-rays are taken. It allows access to the biliary tree in cases where endoscopic retrograde cholangiopancreatography has been unsuccessful. Initially reported in 1937, the procedure became popular in 1952.

<span class="mw-page-title-main">Esophageal food bolus obstruction</span> Medical condition

An esophageal food bolus obstruction is a medical emergency caused by the obstruction of the esophagus by an ingested foreign body.

Therapeutic endoscopy is the medical term for an endoscopic procedure during which treatment is carried out via the endoscope. This contrasts with diagnostic endoscopy, where the aim of the procedure is purely to visualize a part of the gastrointestinal, respiratory or urinary tract in order to aid diagnosis. In practice, a procedure which starts as a diagnostic endoscopy may become a therapeutic endoscopy depending on the findings, such as in cases of upper gastrointestinal bleeding, or the finding of polyps during colonoscopy.

<span class="mw-page-title-main">Jejunostomy</span>

Jejunostomy is the surgical creation of an opening (stoma) through the skin at the front of the abdomen and the wall of the jejunum. It can be performed either endoscopically, or with open surgery.

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References

  1. 1 2 3 Blumenstein, I; Shastri, YM; Stein, J (14 July 2014). "Gastroenteric tube feeding: techniques, problems and solutions". World Journal of Gastroenterology. 20 (26): 8505–24. doi: 10.3748/wjg.v20.i26.8505 . PMC   4093701 . PMID   25024606.
  2. 1 2 3 4 Satiya, J; Marcus, A (27 March 2019). "The Buried Bumper Syndrome: A Catastrophic Complication of Percutaneous Endoscopic Gastrostomy". Cureus. 11 (3): e4330. doi: 10.7759/cureus.4330 . PMC   6538410 . PMID   31183309.
  3. ↑ Lazaridis, N; Murino, A; Telese, A; Koukias, N; Despott, EJ (December 2019). "A multimodality endoscopic approach for the management of buried bumper syndrome". Endoscopy. 51 (12): E410–E411. doi: 10.1055/a-0896-2594 . PMID   31362313.
  4. ↑ Pinho, J; Libânio, D; Pimentel-Nunes, P; Dinis-Ribeiro, M (April 2018). "The Challenging Acute Buried Bumper Syndrome: A Case Report". GE Portuguese Journal of Gastroenterology. 25 (3): 151–153. doi:10.1159/000485104. PMC   5939786 . PMID   29761152.
  5. ↑ Geer, W; Jeanmonod, R (September 2013). "Early presentation of buried bumper syndrome". The Western Journal of Emergency Medicine. 14 (5): 421–3. doi:10.5811/westjem.2013.2.15843. PMC   3789897 . PMID   24106531.
  6. ↑ SHEERS, R; CHAPMAN, S (1 October 1998). "The buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy". Gut. 43 (4): 586. doi:10.1136/gut.43.4.586a. PMC   1727284 . PMID   9882193.
  7. ↑ Biswas, S; Dontukurthy, S; Rosenzweig, MG; Kothuru, R; Abrol, S (2014). "Buried bumper syndrome revisited: a rare but potentially fatal complication of PEG tube placement". Case Reports in Critical Care. 2014: 634953. doi: 10.1155/2014/634953 . PMC   4010002 . PMID   24829838.
  8. 1 2 Klein, S; Heare, BR; Soloway, RD (April 1990). "The "buried bumper syndrome": a complication of percutaneous endoscopic gastrostomy". The American Journal of Gastroenterology. 85 (4): 448–51. PMID   2109527.
  9. ↑ Boyd, JW; DeLegge, MH; Shamburek, RD; Kirby, DF (May 1995). "The buried bumper syndrome: a new technique for safe, endoscopic PEG removal". Gastrointestinal Endoscopy. 41 (5): 508–11. doi:10.1016/s0016-5107(05)80013-6. PMID   7615233.
  10. ↑ Venu, RP; Brown, RD; Pastika, BJ; Erikson LW, Jr (October 2002). "The buried bumper syndrome: a simple management approach in two patients". Gastrointestinal Endoscopy. 56 (4): 582–4. doi:10.1067/mge.2002.128109. PMID   12297784.
  11. ↑ Cyrany, J; Rejchrt, S; Kopacova, M; Bures, J (14 January 2016). "Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy". World Journal of Gastroenterology. 22 (2): 618–27. doi: 10.3748/wjg.v22.i2.618 . PMC   4716063 . PMID   26811611.
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