El Ali Z, Arvanitakis M, Ballarin A, Devière J, Le Moine O, Van Gossum A
Gastroenterology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Acta Gastroenterol Belg. 2011 Jun;74(2):312-6.
Buried bumper syndrome (BBS) is a rare long-term complication of percutaneous endoscopic gastrostomy (PEG) and consists of a progressive impaction of the inner bumper of the tube in the mucosa of gastric wall. The aim of our study was to report our own experience with BBS, focusing on its incidence and endoscopic management.
Medical records of a large group of 879 patients having undergone PEG insertion (2002-2009) were retrospectively reviewed. All PEG's were followed by our special Nutrition Support Team. Patients presenting with BBS during their follow-up were included in the study.
Only eight patients (8/879; 0.9%) developed BBS, which was confirmed during gastroscopy. Median time between PEG insertion and BBS diagnosis was 22.0+/-22.28 months. Five patients underwent successful treatment with: 1) flexible guide wire insertion through the internal orifice of the PEG to define its anatomical settings, 2) cruciform incisions of the gastric mucosa with a needle-knife starting at the center of the mucosal dome covering the internal bumper, and reaching its edges, 3) extrusion and complete extraction of the inner bumper through the gastric tract. No complications were observed. Median hospital stay related to BBS lasted 4.0+/-3.67 days. In two patients with peristomal abscess and deeply migrated bumper surgery was needed.
Cruciform mucosal incisions with needle-knife is a safe endoscopic technique to treat the BBS that could avoid surgery in most of the cases. Preventive measures applied after PEG insertion and continued during the follow-up may result in a distinctly lower prevalence of BBS.
埋藏式胃造口管综合征（BBS）是经皮内镜下胃造口术（PEG）一种罕见的长期并发症，表现为胃造口管的内固定盘在胃壁黏膜中逐渐嵌顿。我们研究的目的是报告我们在BBS方面的经验，重点关注其发生率及内镜治疗方法。
回顾性分析了一大组879例行PEG置入术患者（2002 - 2009年）的病历。所有PEG置入患者均由我们的特殊营养支持团队进行随访。随访期间出现BBS的患者纳入本研究。
仅8例患者（8/879；0.9%）发生BBS，经胃镜检查确诊。PEG置入至BBS诊断的中位时间为22.0±22.28个月。5例患者接受了成功治疗，方法如下：1）通过PEG内口插入柔性导丝以确定其解剖位置；2）用针刀从覆盖内固定盘的黏膜穹顶中心开始，向边缘做十字形胃黏膜切开；3）通过胃肠道将内固定盘挤出并完全取出。未观察到并发症。与BBS相关的中位住院时间为4.0±3.67天。2例出现造口周围脓肿且内固定盘严重移位的患者需要手术治疗。
针刀十字形黏膜切开术是治疗BBS的一种安全的内镜技术，多数情况下可避免手术。PEG置入后及随访期间采取预防措施可能会显著降低BBS的发生率。
