The Cambridge experience with buried bumpers.

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Minimally Invasive Procedures

Background:

• Buried bumper (BB) is a common complication of percutaneous endoscopic gastrostomy (PEG) tubes, often leading to significant patient morbidity.
• Current management strategies for BB, including laparotomy, are invasive and not universally adopted.
• There is a need for safer, less invasive methods to manage BB in pediatric patients.

Purpose of the Study:

• To introduce and evaluate a novel endoscopic retrograde technique for BB removal in pediatric patients.
• To assess the safety, efficacy, and complication rate of this new endoscopic technique.
• To compare the endoscopic approach with traditional methods like laparotomy.

Main Methods:

• Retrospective review of pediatric patients with BB at Cambridge University Hospital (2012-2018).
• Description of the endoscopic technique involving an endoscopic snare for retrograde removal of the PEG tube.
• Data collection included demographics, tube details, time to diagnosis, hospital stay, and outcomes.

Main Results:

• Fifteen BBs were treated in ten pediatric patients using the endoscopic retrograde technique.
• Twelve BBs were successfully removed endoscopically with no postoperative complications.
• Patients experienced short hospital stays (within 24 hours) with replacement tubes inserted via the original track.

Conclusions:

• Endoscopic retrograde BB removal is a safe, effective, and minimally invasive technique for pediatric patients.
• This technique significantly reduces complications and hospital stay compared to laparotomy.
• Widespread adoption of this endoscopic approach is recommended before considering surgical intervention.