Buried bumper syndrome(BBS)is the situation in which the internal bumper of the gastrostomy tube,due to prolonged compression of the tissues between the external and the internal bumper,migrates from the gastric lumen...Buried bumper syndrome(BBS)is the situation in which the internal bumper of the gastrostomy tube,due to prolonged compression of the tissues between the external and the internal bumper,migrates from the gastric lumen into the gastric wall or further,into the tract outside the gastric lumen,ending up anywhere between the stomach mucosa and the surface of the skin.This restricts liquid food from entering the stomach,since the internal opening is obstructed by gastric mucosal overgrowth.We performed a comprehensive search of the PubMed literature to retrieve all the case-reports and case-series referring to BBS and its management,after which we focused on the endoscopic techniques for releasing the internal bumper to re-establish the functionality of the tube.From the“push”and the“push and pull T”techniques to the most sophisticated-using high tech instruments,all 10 published techniques have been critically analysed and the pros and cons presented,in an effort to optimize the criteria of choice based on maximum efficacy and safety.展开更多
BACKGROUND Percutaneous endoscopic gastrostomy(PEG)is a well-established,minimally invasive,and easy to perform procedure for nutrition delivery,applied to individuals unable to swallow for various reasons.PEG has a h...BACKGROUND Percutaneous endoscopic gastrostomy(PEG)is a well-established,minimally invasive,and easy to perform procedure for nutrition delivery,applied to individuals unable to swallow for various reasons.PEG has a high technical success rate of insertion between 95%and 100%in experienced hands,but varying complication rates ranging from 0.4%to 22.5%of cases.AIM To discuss the existing evidence of major procedural complications in PEG,mainly focusing on those that could probably have been avoided,had the endoscopist been more experienced,or less self-confident in relation to the basic safety rules for PEG performance.METHODS After a thorough research of the international literature of a period of more than 30 years of published“case reports”concerning such complications,we critically analyzed only those complications which were considered-after assessment by two experts in PEG performance working separately-to be directly related to a form of malpractice by the endoscopist.RESULTS Malpractice by the endoscopist were considered cases of:Gastrostomy tubes passed through the colon or though the left lateral liver lobe,bleeding after puncture injury of large vessels of the stomach or the peritoneum,peritonitis after viscera damage,and injuries of the esophagus,spleen,and pancreas.CONCLUSION For a safe PEG insertion,the overfilling of the stomach and small bowel with air should be avoided,the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination,and finally,the physician should be more alert with obese patients and those with previous abdominal surgery.展开更多
文摘Buried bumper syndrome(BBS)is the situation in which the internal bumper of the gastrostomy tube,due to prolonged compression of the tissues between the external and the internal bumper,migrates from the gastric lumen into the gastric wall or further,into the tract outside the gastric lumen,ending up anywhere between the stomach mucosa and the surface of the skin.This restricts liquid food from entering the stomach,since the internal opening is obstructed by gastric mucosal overgrowth.We performed a comprehensive search of the PubMed literature to retrieve all the case-reports and case-series referring to BBS and its management,after which we focused on the endoscopic techniques for releasing the internal bumper to re-establish the functionality of the tube.From the“push”and the“push and pull T”techniques to the most sophisticated-using high tech instruments,all 10 published techniques have been critically analysed and the pros and cons presented,in an effort to optimize the criteria of choice based on maximum efficacy and safety.
文摘BACKGROUND Percutaneous endoscopic gastrostomy(PEG)is a well-established,minimally invasive,and easy to perform procedure for nutrition delivery,applied to individuals unable to swallow for various reasons.PEG has a high technical success rate of insertion between 95%and 100%in experienced hands,but varying complication rates ranging from 0.4%to 22.5%of cases.AIM To discuss the existing evidence of major procedural complications in PEG,mainly focusing on those that could probably have been avoided,had the endoscopist been more experienced,or less self-confident in relation to the basic safety rules for PEG performance.METHODS After a thorough research of the international literature of a period of more than 30 years of published“case reports”concerning such complications,we critically analyzed only those complications which were considered-after assessment by two experts in PEG performance working separately-to be directly related to a form of malpractice by the endoscopist.RESULTS Malpractice by the endoscopist were considered cases of:Gastrostomy tubes passed through the colon or though the left lateral liver lobe,bleeding after puncture injury of large vessels of the stomach or the peritoneum,peritonitis after viscera damage,and injuries of the esophagus,spleen,and pancreas.CONCLUSION For a safe PEG insertion,the overfilling of the stomach and small bowel with air should be avoided,the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination,and finally,the physician should be more alert with obese patients and those with previous abdominal surgery.
