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]).
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
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Correction: Management of a case of buried bumper syndrome using an
endoscopic submucosal dissection-based approach
Fasulo Ernesto, Mandarino
Francesco Vito, Barchi Alberto et al. Management of a case of buried bumper syndrome
using an
endoscopic submucosal dissection-based approach.
Endoscopy 2025; 57: E321–E322,
doi:10.1055/a-2578-2649
In the above-mentioned article the title has been corrected.
Correct is the following title: Management of a case of buried bumper syndrome using
an
endoscopic submucosal dissection-based approach. This was corrected in the online
version on
May 05, 2025.
