How to improve success rates of endoscopic management for buried bumper syndrome.

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How to improve success rates of endoscopic management for buried bumper syndrome.

QJM. 2018 Apr 12;:

Authors: Casper M, Lammert F

Abstract
Background: Buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy. Complete BBS without visible parts of the inner bumper is a challenge for endoscopic treatment.
Methods and Aims: Data base analysis of all procedures performed at our tertiary university endoscopy center between 2000 and 2015 was conducted. Our aim was to improve success rates of endoscopic treatment by using a standardized approach and a pull-modification of the papillotome-based extraction technique in a prospective cohort.
Results: Retrospectively 55 patients were identified (37 men; age 54 ± 16 years). The prospective series comprised 11 patients (8 men; age 63 ± 27 years). Patients with partial buried bumper syndrome were effectively treated by endoscopy in both cohorts (24/25 and 4/4 patients respectively). For complete buried bumper syndrome (Cyrany grade 3) success rates of endoscopic therapy differed significantly between the cohorts (p = 0.017). In the retrospective cohort, only 38% of patients (9/24 patients) were successfully treated. In the prospective cohort all 6 patients (deep-type in 5 cases) were managed without complications. Patients with extra-gastric tubes underwent primary surgery in both cohorts (6 and 1 patients respectively).
Conclusion: A structured approach improved success rates of endoscopic treatment. All patients with an internal bumper verified to lie within the gastric wall should be treated by an experienced investigator using a papillotome-based technique.

PMID: 29660086 [PubMed - as supplied by publisher]

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