Management of a case of buried bumper syndrome using an endoscopic submucosal dissection-based approach
Year: 2025
Type: article
Study design: Case Report
Abstract: Buried bumper syndrome (BBS) is a serious complication of percutaneous endoscopic gastrostomy (PEG) characterized by the internal bumper migrating to the gastric or abdominal wall. Its incidence ranges from 0.3 to 2.4% per PEG-patient per year [ 1 ]. Over the years, various strategies for managing BBS have been reported [ 2 ] [ 3 ] [ 4 ], including the development of dedicated endoscopic devices (Flamingo Set; Medwork). We present a case of BBS treated with an endoscopic submucosal dissection (ESD)-based approach ([ Video 1 ]). Quality: mobile 360 480 720 Download BBS treatment using an ESD-based approach. BBS, buried bumper syndrome; ESD, endoscopic submucosal dissection.Video 1 A 69-year-old male with Parkinson’s disease underwent PEG-jejunal (PEG-J) placement for dopaminergic therapy infusion. Two years later, the PEG-J became non-functional, and the patient was referred to our center. Esophagogastroduodenoscopy revealed a gastric bulge suggestive of BBS ([ Fig. 1 ]), which was confirmed by a CT scan. Endoscopic removal was planned using a knife-assisted ESD-based approach. Fig. 1 The preliminary endoscopic view consistent with BBS. BBS, buried bumper syndrome. An initial incision was made near the PEG tube using an L-knife (Finemedix, South Korea) to access the buried bumper bulge. The incision was then progressively widened towards the center to enable mobilization of the tube. Next, an O-knife (Finemedix, South Korea) was used to dissect the surrounding fibrotic tissue ([ Fig. 2 ]). Once freed, the tube was removed to facilitate further dissection. The residual tissue was excised with a hot snare to improve the visualization and clear the working field ([ Fig. 3 ]). Fig. 2 Dissection of the tissue around the PEG tube. PEG, percutaneous endoscopic gastrostomy. Fig. 3 The hot snare used to clear the working field. Fluoroscopy was utilized during the procedure to guide the dissection and confirm the precise localization of the bumper. Once fully exposed, the bumper was securely grasped with foreign body forceps and extracted transorally ([ Fig. 4 ]). In the final fluoroscopic assessment, no contrast leakages were observed ([ Fig. 5 ]). Fig. 4 The extracted bumper. Fig. 5 The final endoscopic view of the dissection defect. The patient was discharged the following day without any complications. Dopaminergic therapy was transitioned to oral formulation. This case highlights that the knife-assisted ESD technique is a minimally invasive and precise approach, offering a safe and effective solution for the endoscopic management of BBS. Endoscopy_UCTN_Code_TTT_1AO_2AK Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 17 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Source: Endoscopy
DOI: 10.1055/a-2578-2649
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4409535086