Buried bumper syndrome: treatment guided by catheter probe US.

Background: The "buried bumper syndrome," caused by migration of the internal bumper into the gastric walls, is a rare complication of PEG. The internal bumper becomes completely overgrown by gastric mucosa. Localization of internal bumpers in relation to the layers of the gastric wall was investigated with catheter probe US to define the optimal therapeutic strategy for PEG removal.

Methods: Eleven patients with the buried bumper syndrome were encountered within 40 months. The internal bumper was localized endosonographically within the gastric and abdominal layers with a 20 MHz catheter US probe. In case of intramural localization, endoscopic extraction was attempted; extramurally located bumpers were removed surgically.

Observations: In 8 patients with an intramural internal bumper, endoscopic PEG removal was achieved without major complication. Mild bleeding after needle knife incision in one case was successfully treated by clip application. In the 3 remaining patients with extragastric localization of the bumper, the PEG was surgically removed.

Conclusion: The position of the internal bumper within the layers of the gastric and abdominal wall can be determined by EUS with high-resolution catheter probes, thereby indicating the appropriate therapeutic approach.