title: Are PEGJs a Risk Factor for the Buried Bumper Syndrome?
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomies (PEGs) with or without a jejunal extension (PEGJs) are a well-accepted method of enteral feeding. They are associated with a number of complications, including the buried bumper syndrome (BBS). We aimed to identify risk factors for BBS, our current management strategies, and optimal timing for surgical treatment.
  
  
  METHODS
  Hospital coding and a database compiled by our specialist nutrition nurse were used to identify all cases of buried bumpers from January 2012 to December 2014 as well as all PEG/PEGJ devices inserted during this time. A retrospective case note review was performed for each patient with BBS to identify risk factors, management strategies, and outcomes.
  
  
  RESULTS
  Two hundred twelve PEGs and 22 PEGJs were inserted. Nine patients were identified with BBS. Patients with PEGJ tubes were significantly more likely to develop BBS (7/22, 32%) than those with PEG tubes (2/212, 0.9%) P<0.01. There was one death in the study group because of abdominal sepsis associated with an intraperitoneal PEG bumper 33days after BBS was diagnosed and before removal was attempted. All other patients underwent laparotomy to remove the bumper. Mean hospital stay was 22days postoperatively.
  
  
  CONCLUSIONS
  Buried bumper syndrome is a serious condition which warrants urgent intervention. We have demonstrated a higher than expected rate of BBS associated with PEGJ tubes. We hypothesize that this may be related to the jejunal extensions leading to difficulty in the usual maintenance regimen that all carers are taught after PEG/PEGJ insertion.
authors.affiliation: The Great North Children's Hospital, Queen Victoria Road, Newcastle Upon Tyne, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Goring
authors.affiliation: The Great North Children's Hospital, Queen Victoria Road, Newcastle Upon Tyne, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Lawson
authors.affiliation: The Great North Children's Hospital, Queen Victoria Road, Newcastle Upon Tyne, United Kingdom. Electronic address: alok.godse@nuth.nhs.uk.
authors.forename: Alok
authors.initials: A
authors.lastname: Godse
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D007583:Jejunum; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome
keywords: Buried bumper syndrome; Gastrostomy; PEG; PEGJ