Removing PEG tubes with 'buried bumpers': Lessons learnt from four patients

Area of Science:

• Gastroenterology
• Medical Devices
• Surgical Complications

Background:

• Increasing incidence of dysfunctional percutaneous endoscopic gastrostomy (PEG) tubes.
• Complication attributed to 'buried bumper syndrome' (BBS).
• Lack of standardized management protocols for BBS.

Purpose of the Study:

• To describe institutional experience in managing buried bumper syndrome (BBS).
• To identify lessons learned from complications and adverse outcomes.
• To evaluate factors influencing successful endoscopic removal of PEG tubes.

Main Methods:

• Retrospective review of patients with dysfunctional PEG tubes due to BBS.
• Description of endoscopic management techniques employed.
• Analysis of patient outcomes and complications.

Main Results:

• Two patient deaths occurred within two weeks of endoscopic therapy.
• Successful endoscopic removal correlated with bumper depth, assessed by wire insertion.
• Deeply impacted bumpers posed significant removal challenges.

Conclusions:

• Endoscopic removal of buried bumper syndrome (BBS) carries substantial risks.
• Depth of bumper impaction is a critical factor for safe removal.
• Pre-intervention risk assessment and consideration of conservative management are crucial for frail patients.