Clinical Manifestations and Management of Buried Bumper Syndrome in Patients with Percutaneous Endoscopic Gastrostomy

BACKGROUND: Buried bumper syndrome has been regarded as an uncommon and late complication after percutaneous endoscopic gastrostomy (PEG) tube insertion. A variety of techniques have been reported to treat this problem, but only a few published cases exist. OBJECTIVE: Our purpose was to present the clinical manifestations and our management of a series of 19 patients with buried bumper syndrome. DESIGN: Case series study. SETTING: Referral medical centers. PATIENTS: Within 5 years, 31 episodes of buried bumper syndrome occurred in 10 men and 9 women. The estimated prevalence was 8.8% (19 in 216 PEG procedures during this period). INTERVENTION: All the buried tubes were removed smoothly by external traction and replaced with a new pull-type feeding tube by the pull method or a button or balloon replacement tube after dilation of the old tract. MAIN OUTCOME MEASUREMENTS: Success rate, complication rate. RESULTS: The duration between occurrence of buried bumper syndrome and PEG placement ranged from 1 to 50 months, with a median of 18 months. All the episodes were treated successfully except for one, in which reinsertion failed and a new PEG tube was inserted 1 week later. No significant complications occurred. LIMITATION: Small sample size. CONCLUSIONS: Buried bumper syndrome is not that uncommon and can occur soon after insertion of a PEG tube. The buried tube can be safely removed by external traction and in most cases can then be replaced with a pull-type or balloon replacement tube.