2017 Volume 59 Issue 8 Pages 1620-1625
Buried bumper syndrome (BBS) occurs when the internal bumper of a percutaneous endoscopic gastrostomy (PEG) tube erodes and migrates through the gastric wall and becomes lodged anywhere between the gastric wall and the skin. If the internal bumper is beyond the gastric wall, BBS is generally treated by surgical repair. If the internal bumper is inside the gastric wall, BBS can be treated by endoscopic needle knife excision or forceful pulling.
A 74-year-old woman presented with a dysfunctional PEG tube and was admitted. She had undergone PEG at the age of 73 years due to dysphagia with progressive supranuclear palsy. Esophagogastroduodenoscopy and computed tomography were performed, and she was diagnosed with BBS. Endoscopic ultrasound (EUS) showed that the buried internal bumper of the PEG tube had migrated completely outside the stomach wall. The buried bumper was safely removed by Funada-style percutaneous gastropexy.
BBS with this degree of migration typically requires surgical repair. The case described herein is the first known case of BBS being successfully treated by external traction with gastropexy. This method eliminated the need for surgical repair. The treatment of BBS with external traction with gastropexy combined with pre-therapeutic EUS was shown to have significant benefits as a treatment for complete-type BBS.
