title: A new endoscopic technique for the buried bumper syndrome.
abstract: BACKGROUND
  The Buried Bumper Syndrome is a well-recognized long-term complication of percutaneous endoscopic gastrostomy (PEG). Overgrowth of gastric mucosa over the inner bumper of the tube will cause mechanical failure of feed delivery, rendering the tube useless. Endoscopic removal is usually attempted but fails in most cases. Therefore, most of the buried inner bumpers are removed by making an external incision over the PEG site under local anaesthesia or at laparotomy. These approaches can be associated with pain, wound infection, or a gastrocutaneous fistula.
  
  
  METHODS
  A new method to facilitate the removal of a PEG tube, where the inner bumper is buried in the gastric mucosa, is described. A length of ureteric catheter, or similar tube, is passed through the shortened external PEG tube into the gastric cavity and is then tied to the tube above the skin. The intragastric part of that tube helps to identify the site of the buried bumper and is then trapped within an endoscopic snare. Traction is then applied to the snare, inverting the tube and dislodging the bumper with minimum disruption to the stomach wall. This avoids the need for repair and allows for immediate reinsertion of a fresh PEG tube.
  
  
  CONCLUSIONS
  A PEG tube in a patient with buried bumper syndrome can be safely removed endoscopically, without a skin incision or gastric wall disruption. A novel, simple, and safe endoscopic removal technique is described.
authors.affiliation: Department of Surgery, Monklands Hospital, Monkscourt Avenue, Airdrie, Lanarkshire, ML6 0LS, United Kingdom.
authors.forename: E
authors.initials: E
authors.lastname: Leung
authors.forename: L
authors.initials: L
authors.lastname: Chung
authors.forename: A
authors.initials: A
authors.lastname: Hamouda
authors.forename: A H M
authors.initials: AH
authors.lastname: Nassar
mesh_terms: D020878:Device Removal / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*