• BBS occurs due to the overgrowth of gastric mucosa over the inner bumper of the gastrostomy tube.
• Overzealous tightening of the external bumper leads to ischaemic necrosis and subsequent ulceration of the gastric mucosa sandwiched between the inner and outer bumper. Subsequent healing causes mucosal overgrowth and burying of the inner bumper.
• The reported incidence of BBS ranges between 1.6 and 6.1%.
• BBS may present as increased leakage around the PEG tube or resistance to infusion or abdominal pain with infusion of feed.
• Diagnosis is obvious at endoscopy

Discuss the management of BBS?

A variety of techniques for the management of this complication have been described. Unfortunately almost all of these methods have the potential for significant complications like bleeding, wound infection and fistula tract formation. There is no standardised clinical protocol for managing BBS. The options are:

• Endoscopic removal (like needle knife technique)
• Surgical removal
• Laparoscopic removal
• Prolonged application of external traction for externally removable PEG

Leaving the buried bumper in situ and inserting a new PEG tube (if needed) may be considered as an option in some patients who are deemed not fit for a more aggressive approach.

Ref

1. Kejariwal D et al. Buried Bumper Syndrome- Cut and Leave it alone! Nutr Clin Pract. 2008 Jun-Jul;23(3):322-24