64 A NOVEL TECHNIQUE FOR ENDOSCOPIC MANAGEMENT OF BURIED BUMPERS IN PAEDIATRIC PEG TUBES
Ayman Goneidy, Georgina Malakounides, Adil Aslam
Addenbrookes Hospital, Cambridge, United Kingdom

Abstract

Aim of study

Buried bumper (BB) is a complication of percutaneous endoscopic gastrostomy (PEG) that leads to tube dysfunction and major morbidity. Although many techniques have been described to manage BB, none are universally adopted and laparotomy remains the mainstay. We describe a novel endoscopic technique that could be used to avoid laparotomy.

Methods

Retrospective case notes were reviewed of patients who presented with BB to a single institution between January 2012 and January 2018. Data collected included: Demographics, type and size of tube, interval between insertion and diagnosis of BB, technique used, hospital stay and any immediate post-operative complications.  The technique involved using an endoscopic snare passed from the stomach into the lumen of the PEG guided by a stiff nylon thread, and snaring the PEG tube outside the body after cutting it short.  This was followed by a retrograde pull to remove the buried tube via the mouth. An appropriate replacement was then placed.  

Main Results

Twelve BB were found in eight patients, four of whom presented twice with BB. 7 of these were PEG-J tubes. Median patient age was 7.6 years (1.2 – 16.6). Median time between gastrostomy insertion and diagnosis of BB was 9.5 months (1-32). There were a variety of underlying diagnoses. Nine BB were removed endoscopically. The procedure resulted in minimal blood loss and no complications. Patients were discharged on the same day as a replacement tube had been placed through the intact track. Two had laparotomies performed by surgeons unfamiliar with endoscopy and one was converted to a laparotomy due to encrusted closed tube lumen.

Conclusion

Endoscopic retrograde BB removal is an effective technique.  It is a safe, easy, quick, and has minimal complications. We strongly advocate the technique before a laparotomy is embarked upon, and offer training and support for its widespread adoption.

 


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