Short article: Buried bumper syndrome in children: incidence and risk factors.
OBJECTIVE
Buried bumper syndrome (BBS) is a serious complication in gastrostomy-dependent children. Many need surgical correction. On account of comorbidities, this becomes a high-risk procedure. Our aim was to review the incidence of BBS in children and to identify the risk factors.


METHODS
Retrospective review of patients' records over 10 years, 2006-2015, was carried out. Types of tubes, operative interventions, comorbidities and records were noted. Two-tailed Fisher's exact test was used for statistical analysis.


RESULTS
A total of 535 patients were reviewed. Overall, 475 had only percutaneous endoscopic gastrostomy (PEG) and 60 had a jejunal extension with percutaneous endoscopic gastrostomy (PEG-J). Twenty-nine patients (PEG-J - 16/26; PEG - 13/26) had a total of 31 BBS episodes. The overall incidence of BBS in our study was 5.4%. The age at presentation ranged from 1 to 18 years (median 8.6 years). All had significant comorbidities (neurodevelopmental 26/29, cardiorespiratory 14/29, genetic 16/29). Overall, 27/29 had two or more comorbidities. The mean time to development of BBS was 1025±634 days. BBS was found in the second or the subsequent tube in four patients with PEGs (P<0.0004) and in 10 PEG-Js (P<0.0001). Twenty-five patients needed laparotomy. There were no postoperative deaths.


CONCLUSIONS
In BBS, the two significant risk factors identified were a having PEG-J and two or more previous gastrostomy insertions. Vigilance in documentation and prolonged follow-up to provide regular education to carers can reduce the incidence of this preventable complication.
Departments of aPaediatric Surgery bPaediatric Gastroenterology, Evelina London Children' Hospital, London, UK.
Claire E
CE
Stewart
Mohamed
M
Mutalib
Akhilesh
A
Pradhan
Christopher
C
Bassett
David
D
Drake
Manasvi
M
Upadhyaya
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004750:Enteral Nutrition; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005774:Gastrostomy; D030342:Genetic Diseases, Inborn / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D065886:Neurodevelopmental Disorders / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology