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Kitchin A, Matull WR, Pearl D. Buried bumper syndrome: improving patient outcomes using a structured multidisciplinary team (MDT) approach to management. Frontline Gastroenterol 2022; 13:503-508. [PMID: 36250177 PMCID: PMC9555139 DOI: 10.1136/flgastro-2021-102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Buried bumper syndrome (BBS) is a complication seen in 2.4% of percutaneous endoscopic gastrostomy (PEG) tubes. We present a case series of 30 patients with BBS managed at a regional referral centre over 13 years. METHODS The original pioneering service (2007-2013) involved sporadic management by various endoscopists or surgeons (group A). More recently (2014-2020), patients with endoscopic or clinically suspected BBS were referred to a specialist multidisciplinary team (MDT) clinic, facilitating a best interest approach to decision making (group B). The objective of this MDT clinic is to plan for an interventional endoscopic procedure under general anaesthesia (GA) with balloon assisted PEG manipulation±needle-knife excision aiming for successful endoscopic feeding tube (FT) replacement through the established tract. RESULTS Results are expressed as group B (n=19) vs group A (n=11). Statistical analysis used Fisher's exact and unpaired t-tests. In group B, less patients required surgery to replace their FT (1 (5.3 %) vs 4 (36.4 %), p<0.05), more FTs were replaced in the pre-existing tract (18 (94.7 %) vs 2 (18.2 %), p<0.001), mean length of stay (LOS) was shorter (4.2 vs 10.5 days, p<0.05) and there were fewer complications (2 (10.5 %) vs 4 (36.4 %), p=0.16). Overall, endoscopic versus surgical management was associated with a shorter LOS (5.3 vs 12 days, p<0.05). CONCLUSION Nuanced decision making as part of a dedicated BBS service, employing MDT decision making and a structured management approach, is associated with improved patient outcomes.
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Affiliation(s)
- Angus Kitchin
- Gastroenterology, Somerset NHS Foundation Trust, Taunton, UK
| | | | - Daniel Pearl
- Gastroenterology, Somerset NHS Foundation Trust, Taunton, UK
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Carter-Stephens R. Buried bumper syndrome: prevention and management in the community. Br J Community Nurs 2021; 26:428-432. [PMID: 34473555 DOI: 10.12968/bjcn.2021.26.9.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a well-established form of artificial nutrition. Buried bumper syndrome (BBS) is a rare but severe complication related to this type of feeding tube. BBS is described as when the internal bumper migrates into the stoma tract and/or the mucosa, and the inner lining of the stomach starts to grow around and over the internal bumper. It can result in pain, infection and the loss of the feeding tube as a port of entry for delivery of nutrition, hydration and medication into the stomach. When suspected, BBS requires urgent referral into specialist hospital services. It is somewhat preventable with appropriate aftercare; however, incidents do occur. The evidence and guidance on care of PEGs differs, and more data and research are needed into the incidence of BBS and what influences it. Access to appropriate nutrition support teams is essential to support patients and their caregivers with all aspects of enteral feeding.
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Affiliation(s)
- Ruth Carter-Stephens
- Community Nutrition Nurse, Nutrition and Dietetic Service, Countess of Chester Hospital and NHS Foundation Trust
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Spanaki C, Boura I, Avgoustaki A, Orfanoudaki E, Giannopoulou IA, Giakoumakis E, Chlouverakis G, Athanasakis E, Koulentaki M. Buried Bumper Syndrome: A common complication of levodopa intestinal infusion for Parkinson disease. Parkinsonism Relat Disord 2021; 85:59-62. [PMID: 33743506 DOI: 10.1016/j.parkreldis.2021.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is required for Levodopa/Carbidopa Intestinal Gel (LCIG) delivery in patients with advanced Parkinson's disease (PD) as well as for enteral feeding in a variety of neurological disorders. Buried Bumper Syndrome (BBS) is a serious complication of PEG. The frequency of BBS in patients receiving LCIG treatment has never been reported. OBJECTIVES To compare the frequency of BBS in patients on LCIG treatment or on enteral feeding over the past 12 years and identify possible risk factors. METHODS We reviewed prospectively recorded data from 2009 to 2020 on two case-series: LCIG-treated PD patients and non-PD patients on enteral nutrition. We identified all BBS incidences. Patients' characteristics, clinical manifestations, BBS management, possible risk factors and outcomes were analyzed. RESULTS During the 12 years, 35 PD patients underwent PEG insertion for LCIG infusion, and 123 non-PD patients for nutritional support. There were eight cases of BBS in six PD patients (17.1%). Six of them were effectively managed without treatment discontinuation. Of the enteral feeding patients, only one developed BBS (0.8%) (p < 0.001). We identified inappropriate PEG site aftercare, weight gain, early onset PD, longer survival, treatment duration, dementia and PEG system design as potential risk factors for BBS development. CONCLUSIONS BBS occurs more frequently in LCIG patients than in patients receiving enteral feeding. If detected early, it can be successfully managed, and serious sequalae or treatment discontinuation can be avoided. Regular endoscopic follow-up visits of LCIG-treated patients and increased awareness in patients and clinicians are recommended.
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Affiliation(s)
- Cleanthe Spanaki
- Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; University of Crete, School of Medicine, Voutes University Campus, Heraklion, 70013, Crete, Greece.
| | - Iro Boura
- Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; University of Crete, School of Medicine, Voutes University Campus, Heraklion, 70013, Crete, Greece
| | - Aikaterini Avgoustaki
- Department of Gastroenterology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| | - Eleni Orfanoudaki
- Department of Gastroenterology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; Department of Gastroenterology, General Hospital of Chania, Mournies, 73300, Chania, Crete, Greece
| | - Irene Areti Giannopoulou
- Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; University of Crete, School of Medicine, Voutes University Campus, Heraklion, 70013, Crete, Greece
| | - Emmanouil Giakoumakis
- Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| | - Gregory Chlouverakis
- Department of Social Medicine, Biostatistics Lab, School of Medicine, University of Crete, Voutes Place, 71500, Heraklion, Crete, Greece
| | - Elias Athanasakis
- Department of General Surgery, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| | - Mairi Koulentaki
- Department of Gastroenterology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
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Boylan C, Barrett D, Li V, Merrick S, Steed H. Longitudinal complications associated with PEG: Rate and severity of 30-day and 1-year complications experienced by patients after primary PEG insertion. Clin Nutr ESPEN 2021; 43:514-521. [PMID: 34024564 DOI: 10.1016/j.clnesp.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Percutaneous Endoscopic Gastrostomy (PEG) feeding is utilised in patients with exceptionally poor oral intake but is associated with both short and long-term complications. This study reviews longitudinal PEG complications and compares key subgroups. METHODS Single-centre retrospective observational study of all patients receiving PEG insertion between January 2016 and December 2018. RESULTS 306 patients met the inclusion criteria. The mean age at insertion was 67 years. The majority were cared for in their own home (80.4%) by themselves or family (74.9%). 127 PEG tubes were inserted for dysphagia and 165 prophylactically prior to treatment for head and neck cancer. In the first 30 days 16.7% experienced a complication. The most frequently reported was peristomal pain (9.2%). In the first year, 35.6% experienced at least one complication, 12.4% two complications and 6.6% three complications and 6.5% required inpatient treatment for their complication. The most common was pain (14.4%) followed by site weeping, site infection and external overgranulation. Patients with dysphagia took longer to develop complications, had fewer complications and took longer to require management by members of the secondary care team than those with head and neck cancer. Discounting peristomal pain, there was no difference in total complications between patients caring for themselves when compared to those receiving professional input. CONCLUSION One third of patients will experience a complication related to their PEG tube over 1 year, but the majority are managed in an outpatient setting. This study has implications for planning support services and consenting and counselling patients pre-PEG-insertion.
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Affiliation(s)
- Conor Boylan
- University of Birmingham, College of Medical and Dental Sciences, United Kingdom.
| | | | - Vincent Li
- Royal Wolverhampton NHS Trust, United Kingdom
| | | | - Helen Steed
- Royal Wolverhampton NHS Trust, University of Wolverhampton, United Kingdom
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Siau K, Troth T, Gibson E, Dhanda A, Robinson L, Fisher NC. How long do percutaneous endoscopic gastrostomy feeding tubes last? A retrospective analysis. Postgrad Med J 2018; 94:469-474. [DOI: 10.1136/postgradmedj-2018-135754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 12/29/2022]
Abstract
BackgroundPercutaneous endoscopic gastrostomy (PEG) tubes allow for long-term enteral feeding. Disk-retained PEG tubes may be suitable for long-term usage without planned replacement, but data on longevity are limited. We aimed to assess the rates and predictors of PEG longevity and post-PEG mortality.DesignSingle-centred retrospective cohort study of patients with disk-retained (Freka) PEG tubes.MethodsAll patients undergoing PEG between 2010 and 2013 were identified, and retrospective analysis of outcomes until 2017 (median 1062 days) was performed. Time-to-event data were plotted using Kaplan-Meier curves, with predictors of survival derived from multivariate Cox-regression analyses.Results277patients were studied, with a median age of 74 years (IQR 59–82). PEG tube failure occurred in 17.4%, due to: buried bumper syndrome (7.0%), split/broken tube (6.3%), peristomal infection (1.8%) and dislodged tube (1.1%). PEG tube longevity was 95.1% (1 year) and 68.5% (5 year), with age <70 (HR 2.65, 95% CI 1.25 to 5.62, p=0.011) being predictive of PEG failure. Post-PEG mortality was 10.5% (30 day), 35.4% (1 year) and 59.7% (5 year). Age ≥70 was associated with mortality (HR 2.79, 95% CI 1.92 to 4.05, p<0.001), whereas PEG failure (HR 0.46, 95% CI 0.27 to 0.77, p=0.003) and elective PEG removal (HR 0.23, 95% CI 0.08 to 0.64, p=0.005) were associated with reduced mortality.Conclusions68.5% of PEG tubes remain intact after 5 years. Younger age was associated with earlier PEG failure, whereas younger age, PEG replacement and elective PEG tube removal were associated with improved survival. These data may inform future guidance for elective PEG tube replacements.
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