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Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
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10.1055/a-2381-4938
E-Videos-2024-01-4734-EV
E-Videos
An atypical endoscopic treatment for “Buried Bumper Syndrome”
http://orcid.org/0000-0002-4998-0105
Cozma Matei-Alexandru MD, PhD
Saunier Maxime Dr.
Berger Arthur Dr.
Zerbib Frank
1 Gastroenterology and Hepatology Department, Colentina Clinical Hospital, Bucharest, Romania
2 Gastroenterology, Hepatology and Digestive Oncology Department, Haut-Lévêque Hospital, Bordeaux, France
Correspondence Matei-Alexandru Cozma, MD, PhD Gastroenterology and Hepatology Department, Colentina Clinical Hospital19-21 Ștefan cel Mare Av.București 020125Romaniamatei.cozma@gmail.com
04 9 2024
12 2024
1 9 2024
56 Suppl 1 E751E752
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/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmc Percutaneous endoscopic gastrostomy (secured using a balloon or by a bumper system) is a widely used method for feeding and nutritional support in patients requiring long-term enteral nutrition. Although considered a safe method, complication rates vary from 0.4% to 22.5% of cases 1 . Buried bumper syndrome (BBS) represents a rare but important complication, with an incidence between 0.3% and 2.4%, and is defined as the migration of the internal bumper anywhere between the gastric wall and the skin, along the gastrostomy tract 2 . Management can be difficult. Historically represented by surgical methods, management now involves a variety of endoscopic devices, including needle-knives, wire-guided papillotome, or the Flamingo-type sphincterotome 3 .

We present the case of a 62-year-old patient who underwent gastrostomy with a bumper fixation system by the peroral pull technique (the Ponsky method), during prolonged hospitalization for cardiorespiratory arrest secondary to acute myocardial infarction. Owing to low compliance and repeated attempts of self-extraction, the gastrostomy was removed using the “cut and push” method. Afterwards, the patient presented with cutaneous discharge of gastric fluid, painful induration, and superficial periorificial ulceration. Diagnosis of BBS was suspected following a computed tomography, which highlighted the persistence of a foreign body in contact with the anterior gastric wall ( Fig. 1 ), and confirmed by upper endoscopy, which showed the presence of a 2-cm submucosal lesion, with a central millimetric orifice and continuous purulent discharge ( Fig. 2 ).

Fig. 1 Computed tomography image of the internal bumper of the gastrostomy in the anterior abdominal wall.

Fig. 2 Endoscopic view of the submucosal cavity containing the internal bumper of the gastrostomy.

The removal technique consisted of endoscopic submucosal dissection (ESD) using a 2.0 DualKnife device (Olympus, Tokyo, Japan), assisted by an elastic traction system. Dissection further exposed the buried bumper, which was later removed using a simple biopsy forceps. Finally, the remaining cavity was closed with four hemostatic clips ( Video 1 ). We report no intra- or post-procedural complications during the 3-month endoscopic follow-up.

Dissection of the abscessed cavity in the anterior gastric wall, followed by successful removal of the internal bumper and closure of the incision.

Video 1

Multiple cases describing ESD as a treatment method for BBS are reported in the literature 4 5 . Advantages include a low complication rate and a short recovery time. In experienced centers, ESD appears to be a safe, effective, and less invasive option for the treatment of BBS.

Endoscopy_UCTN_Code_CPL_1AH_2AI

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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 .

Conflict of Interest The authors declare that they have no conflict of interest.
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References

1 Cyrany J Buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy World J Gastroenterol 2016 22 618 10.3748/wjg.v22.i2.618 26811611
2 Boeykens K Duysburgh I Prevention and management of major complications in percutaneous endoscopic gastrostomy BMJ Open Gastroenterol 2021 8 e000628 10.1136/bmjgast-2021-000628
3 Chong VH Management of buried bumper syndrome QJM: An International Journal of Medicine 2019 112 153 153 10.1093/qjmed/hcy176 30125005
4 Bathobakae L Leone C Elagami MM Acute buried bumper syndrome: a case report Cureus 2023 15 e36289 10.7759/cureus.36289 37073205
5 Curcio G Granata A Ligresti D Buried bumper syndrome treated with HybridKnife endoscopic submucosal dissection Gastrointest Endosc 2014 80 916 917 25436407
