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Pediatric Buried Bumper Syndrome: Diagnostic Validity of Transabdominal Ultrasound and Artificial Intelligence
Caroline Aguilar1, Adrian P Regensburger1, Ferdinand Knieling1
1Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany.
Insights
Transabdominal ultrasound (US) accurately diagnoses buried bumper syndrome (BBS) in children, offering a rapid, noninvasive alternative to endoscopy. This diagnostic approach can help avoid unnecessary invasive procedures for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Artificial Intelligence in Medicine
Background:
- Buried bumper syndrome (BBS) is a serious complication of percutaneous endoscopic gastrostomy (PEG).
- It involves gastric mucosa overgrowth and inner holding plate penetration into the gastric wall.
- Accurate and timely diagnosis is crucial for effective management in children.
Purpose of the Study:
- To evaluate the diagnostic performance of transabdominal ultrasound (US) for BBS in pediatric patients.
- To compare US diagnostic accuracy against an artificial intelligence (AI) model.
- To identify clinical risk factors associated with pediatric BBS.
Main Methods:
- A monocentric retrospective analysis of pediatric US data for BBS from 2009-2019.
- Comparison of US findings with a multiparameter AI model and endoscopy (reference standard).
- Determination of clinical risk factors for BBS occurrence.
Main Results:
- US correctly assessed PEG inner holding plate placement in 121 examinations (82 patients).
- BBS was confirmed in 18 cases, with US achieving 100% recall and precision.
- Key risk factors identified included PEG mobilization issues, secretion, time since PEG placement, and elevated leukocyte count.
Conclusions:
- Transabdominal US provides a correct, rapid, and noninvasive method for diagnosing BBS in children.
- AI models can potentially support the diagnostic process.
- US should be considered a primary diagnostic tool for suspected BBS to minimize invasive procedures.
Purpose:
Buried bumper syndrome (BBS) is a severe complication of percutaneous endoscopic gastrostomy (PEG) resulting from overgrowth of gastric mucosa and penetration of the inner holding plate into the gastric wall. The aim of this study was to evaluate the diagnostic value of transabdominal ultrasound (US) in comparison to an artificial intelligence (AI) model for the diagnosis of BBS in children.
Materials And Methods:
In this monocentric retrospective study, pediatric US data concerning BBS from a ten-year period (2009-2019) were analyzed. US findings were compared to a clinical multiparameter-based AI model and reference standard endoscopy. Clinical risk factors for the occurrence of pediatric BBS were determined.
Results:
In n = 121 independent examinations of n = 82 patients, the placement of the inner holding plate of the PEG was assessed by US. In n = 18 cases BBS was confirmed. Recall and precision rates were 100 % for US and 88 % for the AI-based assessment. Risk factors for the occurrence of BBS were mobilization problems of the PEG (rs = 0.66, p < 0.001), secretion/exudation (rs = 0.29, p = 0.002), time between 1st PEG placement and US (rs = 0.38, p < 0.001), and elevated leukocyte count (rs = 0.24, p = 0.016).
Conclusion:
Transabdominal US enables correct, rapid, and noninvasive diagnosis of BBS in pediatric patients. Preceding AI models could aid during diagnostic workup. To avoid unnecessary invasive procedures, US could be considered as a primary diagnostic procedure in suspected BBS. .
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