Endoscopic Versus Surgical Management of Buried Bumper Syndrome: A Systematic Review and Analysis of Contemporary...

Buried Bumper Syndrome (BBS) is a significant complication of percutaneous endoscopic gastrostomy (PEG). Management strategies vary between endoscopic and surgical approaches. This systematic review compares the efficacy and outcomes of these modalities based on contemporary evidence.

A systematic literature search was conducted across multiple databases (MedLine, Scopus, Embase, Web of Knowledge) for studies reporting on BBS management. Case reports, case series, and cohort studies were included. Data on patient demographics, treatment type (conservative, endoscopic, surgical), and outcomes (success, morbidity) were extracted and analyzed.

Analysis of 104 patients from case reports/series and 276 from modern cohorts was performed. In the detailed cohort, endoscopic management (n=63) had a success rate of 92.1% with 7.9% failure and 6.3% morbidity. Surgical management (n=25) had a 100% success rate and 8% morbidity. Modern management data (n=276) revealed an overwhelming preference for endoscopy (97.4%), with a very low rate of primary (2.6%) and salvage (1.9%) surgery CONCLUSIONS: Endoscopic management is the established first-line therapy for BBS, demonstrating high efficacy and safety in large, contemporary studies. Surgical intervention is highly effective but reserved for complex cases or after endoscopic failure, representing a crucial salvage option. This reflects a definitive paradigm shift towards minimally invasive endoscopic techniques as the standard of care.