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Enteral nutrition
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Occasionally, a disc retention device will be found to have migrated into the submucosal tissues so that it cannot be seen at endoscopy (the ‘buried bumper syndrome’). The site of the PEG is then marked by a heaped-up area of gastric mucosa with a central depression. This is more likely to occur if a PEG tube has been fixed too tightly or has not been slackened off to allow for increased adipose tissue in the abdominal wall with improved nutrition. Removal of the disc may require surgical exploration, but a recently described alternative is to use a small-calibre dilatation balloon to push the disc back into the stomach at the same time as dilating the track (Fig. 8.13).
Percutaneous Endoscopic Gastrostomy
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
Complications of PEG can be major or minor and the overall rate (major and minor) ranges from 0.4% to 22.5%.25, 26 Peritonitis, haemorrhage, aspiration and death are examples of major complications and peristomal wound infection, buried bumper syndrome where gastric part of the tube migrates into the gastric wall, and gastrocolic fistula are some examples of the minor complications.
Access for enteral nutrition
Published in Prem Puri, Newborn Surgery, 2017
Michael W. L. Gauderer, Julia Zimmer
Overzealous approximation of external immobilizing devices, such as the bumper, can lead to embedding of the inner crossbar of the PEG catheter, mushroom tip, or balloon in the gastric and abdominal wall.1 The resulting so-called buried bumper syndrome (BBS) is defined as the migration of the internal fixation device (bumper) of the PEG tube alongside the stoma tract out of the stomach over a variable distance with complete or partial loss of tract patency between the stomach and the PEG tube tip. 16,63 The bumper can end up anywhere between the stomach mucosa and the skin surface, which is typical for rigid or semirigid internal immobilization devices.63
Metastasis to the gastrostomy site in a patient with pharynx cancer after percutaneous endoscopic gastrostomy: a case report
Published in Scandinavian Journal of Gastroenterology, 2020
Miroslav Vujasinovic, Åke Öst, Rusana Bark, Torkel Brismar, Boel Hynning, Mats Lindblad, Peter Elbe
Percutaneous endoscopic gastrostomy (PEG) is a simple and effective method for providing enteral nutrition in patients with swallowing disorders [1]. A stenosing tumour in the throat region is a common indication for PEG, which may be used for enteral nutrition in palliative cases or placed prior to curative treatment (surgery, radiotherapy and/or chemotherapy) and removed when the patient has recovered and has a reliable and adequate oral intake [2]. Most complications associated with PEG placement are minor in the form of redness, tenderness or leakage at the site of incision [3]. Major complications such as perforation, serious abdominal haemorrhage, peritonitis or buried bumper syndrome, which require surgical intervention, occur in approximately 1–4% of cases [2]. A complication that is unique to PEG placement in oesophageal cancers and head and neck cancers (HNC) is inducing metastases at the gastrostomy site, which occurs in 0.5–3.0% of patients with HNC [4,5]. We present a case of metastases of pharyngeal squamous cell carcinoma at the PEG site.
Complications and outcome of percutaneous endoscopic gastrostomy in a high-volume centre
Published in Scandinavian Journal of Gastroenterology, 2019
Miroslav Vujasinovic, Caroline Ingre, Francisco Baldaque Silva, Filippa Frederiksen, Jingru Yu, Peter Elbe
Major complications occurred in 10 (2.0%) patients. Clinical signs of infection with elevated laboratory parameters (C-reactive protein) developed in 4 (0.8%) patients, all of whom were treated successfully with intravenous antibiotics. In 3 (0.6%) patients, haematemesis occurred after the PEG placement. In patients with reported haematemesis, control gastroscopy was not performed due to the transient character and clinical/laboratory stabile status. Finally, in 3 (0.6%) patients, buried bumper syndrome occurred: 32, 63 and 248 days after PEG insertion. Eight (1.6%) patients died within 7 days of PEG insertion (4 from the neurology group, 2 from the group with other diagnosis and 1 from the oncology group). However, PEG was not the direct cause of death in any of these cases.
Percutaneous endoscopic gastrostomy: dealing with the issue of dislodgement
Published in Scandinavian Journal of Gastroenterology, 2020
Rui de Sousa Magalhães, Tiago Cúrdia Gonçalves, Bernardo Sousa-Pinto, Bruno Rosa, Carla Marinho, José Cotter
In our study we report a one year mortality rate of 43%. This finding was similar to previous reports, with rates up to 42% [22,25,26]. It is important to highlight that mortality rates are far more correlated with intrinsic comorbidities and underlying disease than PEG related death. In most studies, PEG related death accounts for merely 1% overall mortality [4]. In our cohort, only one death was PEG related, a buried bumper syndrome that progressively induced sepsis and death.