title: Buried bumper syndrome: low incidence and safe endoscopic management.
abstract: OBJECTIVE
  Buried bumper syndrome (BBS) is a rare long-term complication of percutaneous endoscopic gastrostomy (PEG) and consists of a progressive impaction of the inner bumper of the tube in the mucosa of gastric wall. The aim of our study was to report our own experience with BBS, focusing on its incidence and endoscopic management.
  
  
  METHODS
  Medical records of a large group of 879 patients having undergone PEG insertion (2002-2009) were retrospectively reviewed. All PEG's were followed by our special Nutrition Support Team. Patients presenting with BBS during their follow-up were included in the study.
  
  
  RESULTS
  Only eight patients (8/879; 0.9%) developed BBS, which was confirmed during gastroscopy. Median time between PEG insertion and BBS diagnosis was 22.0+/-22.28 months. Five patients underwent successful treatment with: 1) flexible guide wire insertion through the internal orifice of the PEG to define its anatomical settings, 2) cruciform incisions of the gastric mucosa with a needle-knife starting at the center of the mucosal dome covering the internal bumper, and reaching its edges, 3) extrusion and complete extraction of the inner bumper through the gastric tract. No complications were observed. Median hospital stay related to BBS lasted 4.0+/-3.67 days. In two patients with peristomal abscess and deeply migrated bumper surgery was needed.
  
  
  CONCLUSIONS
  Cruciform mucosal incisions with needle-knife is a safe endoscopic technique to treat the BBS that could avoid surgery in most of the cases. Preventive measures applied after PEG insertion and continued during the follow-up may result in a distinctly lower prevalence of BBS.
authors.affiliation: Gastroenterology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Ali Z
authors.initials: AZ
authors.lastname: El
authors.forename: M
authors.initials: M
authors.lastname: Arvanitakis
authors.forename: A
authors.initials: A
authors.lastname: Ballarin
authors.forename: J
authors.initials: J
authors.lastname: Devière
authors.forename: O
authors.initials: O
authors.lastname: Le Moine
authors.forename: A
authors.initials: A
authors.lastname: Van Gossum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D020878:Device Removal / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005547:Foreign Bodies / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach; D013577:Syndrome; D055815:Young Adult