Buried bumper sendromunun Savary-Gilliard bujisi ile tedavisi


Buried bumper syndrome treated with Savary-Gilliard dilator


Şehmus ÖLMEZ1, Bünyamin SARITAŞ2, Mesut AYDIN1, Ergin TURGUT3

Departments of 1Gastroenterology, 3Internal Medicine, Yüzüncü Yıl University, School of Medicine, Van Department of 2Gastroentrology, Medical Park Hospital, Elazığ

Anahtar Kelimeler: Buried bumper sendromu, Savary-Gilliard dilatatör

Keywords: Buried bumper syndrome, Savary-Gilliard dilator

Makale PdfEndoskopi künye


Özet

Perkütan endoskopik gastrostomi, normal bağırsak fonksiyonları olan, ancak değişik nedenlerle yutamayan hastalarda uzun dönemli beslenmeyi sağlamada etkin ve güvenilir bir yöntemdir. Bazı hastalarda gastrostomi tüpünün mide duvarı içine ilerlemesi sonucu nadir görülen bir komplikasyon olan buried bumper sendromu görülebilir. Burada buried bumper sendromu olan ve Savary-Gilliard bujisi ile başarılı bir şekilde tedavi edilen bir hastayı sunacağız.


Abstract

Percutaneous endoscopic gastrostomy is a safe and effective method for providing long term enteral nutrition in patients who cannot swallow, but who have intact gut function. A complication of migration of the internal bumper into the gastric or abdominal wall, called buried bumper syndrome, may happen in some patients. We report a rare case of buried bumper syndrome successfully treated with a Savary-Gilliard dilator.


Giriş

Percutaneous endoscopic gastrostomy (PEG) is a safe and effective method for providing long term enteral nutrition in patients who cannot swallow, but who have intact gut function (1,2). A complication of migration of the internal bumper into the gastric or abdominal wall is called ‘‘buried bumper syndrome’’ and was described (BBS) by Klein et al (3). Surgical and endoscopic treatments are performed to treat BBS. Although, endoscopic techniques vary, treatment with Savary-Gilliard dilator (SGD) is a rarely used method (4,5). Here we report a case of buried bumper syndrome successfully treated with SGD, which included the placement of a new PEG tube


Olgu

A 72 years old male patient who had a PEG tube for 4 years was admitted to our hospital for a week due to a nonfunctional PEG tube. The patient had a 4-year medical history of amyotrophic lateral sclerosis (ALS). He had a tracheostomy and was on home mechanical ventilation due to respiratory failure. Physical examination revealed erityhema and swelling at the PEG insertion area. It was not possible to move the PEG tube, or to inject water into it. Endoscopic examination revealed BBS (Figure 1). The bumper could not be removed with snare and traction. Surgical removal was planned but due to the patient’s high-risk situation, endoscopic treatment was performed. We pushed the buried tube into the stomach using 15 mm Savary-Gilliard Dilator (Figure 2), and then removed the bumper using a snare. After the removal, a new PEG tube was placed in a different area of the stomach (Figure 3). There were no complications related to the procedure.


Gereç ve Yöntem



Tartışma

BBS is a rare, serious, and late complication of PEG insertion, with a prevalence ranging from 0.3% to 2.4% (4). Several endoscopic treatment options may be used for BBS, but there is no standardized method. Endoscopic treatment should be used in high risk patients. We think that endoscopic treatment with SGD is an easily applicable, effective and safe method for the removal of a PEG tube


Kaynaklar

1. Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987;93:48-52. 2. Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J Gastroenterol Hepatol 2000;15:21-5. 3. Klein S, Heare BR, Soloway RD. The ‘‘buried bumper syndrome’’: a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol 1990;85:448-51. 4. Lee TH, Lin JT. Clinical manifestations and management of buried bumper syndrome in patients with percutaneous endoscopic gastrostomy. Gastrointest Endosc 2008;68:580-4. 5. Rieder B, Pfeiffer A. Treatment of the Buried Bumper Syndrome using a Savary Dilator. Endoscopy 2008;40(Suppl 2):E115.