title: [Buried bumper syndrome: A new classification and therapy algorithm].
abstract: BACKGROUND
  Buried bumper syndrome (BBS) is a severe complication of percutaneous endoscopic gastrostomy (PEG) based on the overgrowth of gastric mucosa over the inner bumper of a PEG and migration into the gastric or abdominal wall and with a highly variable incidence ranging between 0.9 and > 8 %. However, no classification has yet been described setting the extent of migration of the inner bumper in relation to therapy and the related risk, especially of perforation.
  
  
  OBJECTIVE
  In the past 12 years 38 patients presented with BBS. Initially, an attempt was made to treat all BBS patients endoscopically. A structured BBS classification into four types for estimation of the therapy risk was developed.
  
  
  METHODS
  BBS classification: IA: inner bumper partially extrakorporeal or subcutaneous with and without fistula; IB: inner bumper completely extrakorporeal, full thickness focal defect; II: partially visible inner bumper inside the stomach, good degree of mobility; IV: deep type., inner bumper not visible, mucosa without mobility.
  
  
  RESULTS
  Up to August 2014, examiners with different degrees of experience classified and treated 17 BBS patients according to the algorithm described above (type IA n = 2, type IB n = 2, type II n = 3, type III n = 4 and type IV n = 6). Problem-free endoscopic therapy was possible in all of the patients in whom good mucosa mobilization with or without partial identification of the inner PEG bumper could be previously induced.
  
  
  CONCLUSIONS
  The classification serves as an aid and takes both the therapist's experience and patient safety into consideration. In estimating the risk, it considers the following prevailing circumstances: More stringent obligation for patient information under the Patient Rights Act, with presentation of possibly necessary expansion of therapy; the obligation to cite relative alternative treatments; prior check of the resources available (specialist/surgery available yes/no).
authors: Interdisziplinäre Endoskopie, Kliniken für Innere Medizin II und Allgemein- und Viszeralchirurgie, Universitätsklinik Freiburg, Sir Hans A. Krebs Str., 79106, Freiburg im Breisgau, Deutschland. hans-juergen.schrag@uniklinik-freiburg.de.
authors: H-J
authors: HJ
authors: Richter-Schrag
authors: Interdisziplinäre Endoskopie, Kliniken für Innere Medizin II und Allgemein- und Viszeralchirurgie, Universitätsklinik Freiburg, Sir Hans A. Krebs Str., 79106, Freiburg im Breisgau, Deutschland.
authors: A
authors: A
authors: Fischer
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000465:Algorithms; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D005548:Foreign-Body Migration / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D005753:Gastric Mucosa / Q000601:surgery; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation*; D006097:Granulation Tissue / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000145:classification* / Q000175:diagnosis / Q000601:surgery*; D012307:Risk Factors; D013577:Syndrome
keywords: Buried bumper syndrome; Complications; Inner bumper; Migration; Percutaneous endoscopic gastrostomy
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