Endoscopic therapy of the buried bumper syndrome: a clinical algorithm

Background: Buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy with an overgrowth of the inner flange of the tube. Various therapeutic approaches in case studies in the literature are described. Methods: We present the prospective data collection and analysis of 18 cases of buried bumper syndrome treated in our institution between I January 1998 and 31 December 2005. Results: The median length of time after the first percutaneous endoscopic gastrostomy (PEG) tube insertion was 35 months (range = 1-168 months). In 37 endoscopic interventions all ingrown PEG's could be removed or replaced. Our experience resulted in a structured clinical treatment algorithm. Conclusion: In all cases inadequate gastrostomy care must be assumed as the reason for bumper overgrowth. Following ESPEN guidelines for PEG care may prevent BBS. BBS can routinely be diagnosed and treated by upper gastrointestinal endoscopy in a minimally invasive manner.