Treatment of the Buried Bumper Syndrome: A Retrospective Multicenter Study With Inclusion of 160 Cases.
Journal
Journal of clinical gastroenterology
ISSN: 1539-2031
Titre abrégé: J Clin Gastroenterol
Pays: United States
ID NLM: 7910017
Informations de publication
Date de publication:
16 Jul 2024
16 Jul 2024
Historique:
received:
03
01
2024
accepted:
31
03
2024
medline:
15
7
2024
pubmed:
15
7
2024
entrez:
15
7
2024
Statut:
aheadofprint
Résumé
The therapy of buried bumper syndrome (BBS) is difficult. The aim of this retrospective multicenter study was to analyze the treatment methods with focus on effectiveness and safety of endoscopic techniques. The analysis of all therapies and a comparison of the papillotome technique (PT) and needle knife-based nonpapillotome technique (NPT) were performed. Primary endpoint was technical success in one session, secondary endpoints overall technical success, number and duration of treatment sessions, SAE, and mortality. The primary treatment of 160 BBS cases, diagnosed between 2003 and 2021, was NPT in 60 (37.5%), PT in 43 (26.9%), push/pull technique (PPT) in 40 (25.0%), no removal in 9 (5.6%), laparotomy in 7 (4.4%) cases, and external incision in 1 (0.6%) case. For PT and NPT rates of technical success in one session were 95.5% and 45.0% (P<0.01), rates of overall technical success 100% and 88.3% (P=0.02), and mean number and duration of treatment sessions 1.05 (±0.21) versus 1.70 (±0.91) (P<0.01) and 32.17 (±21.73) versus 98,00 (±62.28) minutes (P<0.01), respectively. No significant differences between PT and NPT were found for SAE (15.9% vs. 25.0%) and mortality (2.3% vs. 1.7%). For PPT, laparotomy and external incision rates of technical success in one session and overall technical success were 100%, rates of SAE 2.5%, 50.0%, and 0% and mortality 0%, 10.0%, and 0%. Endoscopic therapy of BBS is treatment of choice in most cases with removal of incomplete BB by PPT. In case of complete BB PT appears more effective than NPT.
Sections du résumé
BACKGROUND AND GOALS
OBJECTIVE
The therapy of buried bumper syndrome (BBS) is difficult. The aim of this retrospective multicenter study was to analyze the treatment methods with focus on effectiveness and safety of endoscopic techniques.
METHODS
METHODS
The analysis of all therapies and a comparison of the papillotome technique (PT) and needle knife-based nonpapillotome technique (NPT) were performed. Primary endpoint was technical success in one session, secondary endpoints overall technical success, number and duration of treatment sessions, SAE, and mortality.
RESULTS
RESULTS
The primary treatment of 160 BBS cases, diagnosed between 2003 and 2021, was NPT in 60 (37.5%), PT in 43 (26.9%), push/pull technique (PPT) in 40 (25.0%), no removal in 9 (5.6%), laparotomy in 7 (4.4%) cases, and external incision in 1 (0.6%) case. For PT and NPT rates of technical success in one session were 95.5% and 45.0% (P<0.01), rates of overall technical success 100% and 88.3% (P=0.02), and mean number and duration of treatment sessions 1.05 (±0.21) versus 1.70 (±0.91) (P<0.01) and 32.17 (±21.73) versus 98,00 (±62.28) minutes (P<0.01), respectively. No significant differences between PT and NPT were found for SAE (15.9% vs. 25.0%) and mortality (2.3% vs. 1.7%). For PPT, laparotomy and external incision rates of technical success in one session and overall technical success were 100%, rates of SAE 2.5%, 50.0%, and 0% and mortality 0%, 10.0%, and 0%.
CONCLUSIONS
CONCLUSIONS
Endoscopic therapy of BBS is treatment of choice in most cases with removal of incomplete BB by PPT. In case of complete BB PT appears more effective than NPT.
Identifiants
pubmed: 39008571
doi: 10.1097/MCG.0000000000002018
pii: 00004836-990000000-00316
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Références
Gawenda M, Schmidt R, Schonau E. The buried bumper syndrome—a rare complication of percutaneous endoscopic gastrostomy. Chirurg. 1996;67:752–753.
Braden B, Brandstaetter M, Caspary WF, et al. Buried bumper syndrome: treatment guided by catheter probe US. Gastrointest Endosc. 2003;57:747–751.
El Ali Z, Arvanitakis M, Ballarin A, et al. Buried bumper: low incidence and safe endoscopic management. Acta Gastroenterol Belg. 2011;74:312–316.
Finocchiaro C, Galletti R, Rovera G, et al. Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition. 1997;13:520–523.
Piskac P, Wasikov S, Hn.zdil L, et al. Buried bumper syndrome (BBS) as a complication of percutaneous endoscopic gastrostomy. Rozhl Chir. 2010;89:298–299.
Boreham B, Ammori BJ. Laparoscopic percutaneous endoscopic gastrostomy removal in a patient with buried-bumper syndrome: a new approach. Surg Laparosc Endosc Percutan Tech. 2002;12:356–358.
Ballester P, Ammori BJ. Laparoscopic removal and replacement of tube gastrostomy in the management of buried bumper syndrome. Internet J Surg. 2004;5:2.
Ehsan S, Dyall L, Ubhi S. A novel laparoscopic approach for the surgical management of buried bumper syndrome. Ann R Coll Surg Engl. 2012;94:61–62.
Fay DE, Luther R, Gruber M. A single procedure endoscopic technique for replacing partially extruded percutaneous endoscopic gastrotomy tubes. Gastrointest Endosc. 1990;36:298–300.
Köhler H, Lang T, Behrens R. Buried bumper syndrome after percutaneous endoscopic gastrostomy in children and adolescents. Endoscopy. 2008;40 2:E85–E86.
Grund KE, Ingenpa R, K.nigsrainer I, et al. Endoscopic Techniques for Enteral Nutricion: Tips and Tricks [article in German]. Endo heute. 2007;20:28–32.
Sauer B, Starlitz M. Buried bumper—a new method of non-surgical removal. Z Gastroenterol. 2004;42:227–232.
Frascio F, Giacosa A, Piero P, et al. Another approach to the buried bumper syndrome. Gastrointest Endosc. 1996;43:263.
Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: a critical analysis of endoscopic release techniques. World J Gastrointest Endosc. 2023;15:44–55.
Klein S, Heare BR, Soloway RD. The buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1990;85:448–451.
Ma MM, Semlacher EA, Fedorak RN, et al. The buried gastrostomy bumper syndrome: prevention and endoscopic approaches to removal. Gastrointest Endosc. 1995;41:505–508.
Rieder B, Pfeiffer A. Treatment of the buried Bumper syndrome using a Savary Dilator. Endoscopy. 2007;39:E115.
Bittinger M, Schmidbaur W, Fleischmann R, et al. The buried bumper syndrome as a long-term complication of percutaneous endoscopic gastrostomy (PEG): management in a tertiary care center. Gastrointest Endosc. 2005;61:AB161.
Horbach T, Teske V, Hohenberger W, et al. Endoscopic therapy of the buried bumper syndrome: a clinical algorithm. Surg Endosc. 2007;21:1359–1362.
Curcio G, Granata A, Ligresti D, et al. Buried bumper syndrome treated with Hybrid Knife endoscopic submucosal dissection. Gastrointest Endosc. 2014;80:916–917.
Wolpert LE, Summers DM, Tsang A. Novel endoscopic management of buried bumper syndrome in percutaneous endoscopic gastrostomy: the Olympus Hook knife. World J Gastroenterol. 2017;23:6546–6548.
Müller-Gerbes D, Aymaz S, Dormann J. Management of the buried bumper syndrome: a new minimally invasive technique—the push method [article in German]. Z Gastroenterol. 2009;47:1145–1148.
Mueller-Gerbes D, Hartmann B, Pereira Lima J, et al. Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients. Endosc Int Open. 2017;05:E603–E607.
Wannhoff A, Kuellmer A, Albers D, et al. Randomized controlled trial comparing a novel and dedicated device to conventional endoscopic techniques for the treatment of buried bumper syndrome. Gastrointest Endosc. 2024;99:23.e1–30.e1.
Richter-Schrag H-J, Fischer A. Buried bumper syndrome: A new classification and therapy algorithm [article in German]. Chirurg. 2015;86:963–969.
Cyrany J, Repak R, Douda T, et al. Buried bumper syndrome—management based on accurate staging. United European Gastroenterol J. 2014;2(suppl 1):A170.
Casper M, Lammert F. How to improve success rates of endoscopic management for buried bumper syndrome. QJM. 2018;111:467–472.
Lee TH, Lin JT. Clinical manifestations and management of buried bumper syndrome in patients with percutaneous endoscopic gastrostomy. Gastrointest Endosc. 2008;68:580–584.
Turner P, Deakin M. Percutaneous endoscopic gastrostomy tube removal and replacement after “buried bumper syndrome”: the simple way. Surg Endosc. 2009;23:1914–1917.
Cyrany J, Repak R, Douda T, et al. Cannulotome introduced via a percutaneous endoscopic gastrostomy (PEG) tube—new technique for release of a buried bumper. Endoscopy. 2012;44:E422–E423.
Costa D, Despott E, Lazaridis N, et al. Multicenter cohort study of patients with buried bumper syndrome treated endoscopically with a novel, dedicated device. Gastrointest Endosc. 2020;93:1325–1332.
Richter-Schrag HJ, Richter S, Ruthmann O, et al. Risk factors and complications following percutaneous endoscopic gastrostomy: a case series of 1041 patients. Can J Gastroenterol. 2011;25:201–206.
Kejariwal D, Aravinthan A, Bromley D, et al. Buried bumper syndrome: cut and leave it alone!. Nutr Clin Pract. 2008;23:322–324.
Mathus-Vliegen LM, Koning H. Percutaneous endoscopic gastrostomy and gastrojejunostomy: critical reappraisal of patient selection, tube function and the feasibility of nutritional support during extended follow-up. Gastrointest Endosc. 1999;50:746–754.