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Observed high incidence of buried bumper syndrome associated with Freka PEG tubes
  1. Joanna K Dowman1,
  2. Linda Ditchburn1,
  3. Warren Chapman1,
  4. Par Lidder2,
  5. Nicola Wootton1,
  6. Nicola Ryan2,
  7. Rachel M Cooney1
  1. 1Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, UK
  2. 2Sandwell and West Birmingham NHS Trust, Sandwell General Hospital, West Bromwich, UK
  1. Correspondence to Dr Rachel M Cooney, City Hospital, Dudley Road, Birmingham B18 7QH, UK; rachel.cooney{at}


Background Buried bumper syndrome (BBS) is an uncommon but significant complication of percutaneous endoscopic gastrostomy (PEG), which occurs due to overgrowth of gastric mucosa over the inner bumper of the gastrostomy tube. A high incidence of BBS was observed in patients with Freka PEG tubes.

Objective To review case numbers of BBS and confirm the observed association with Freka tubes to determine whether change of practice should be considered.

Design Data was collected on the number of cases of BBS reported to the community nutrition team Birmingham, UK. Data on type of PEG kit and total number of PEGs inserted between 2009 and 2013 were collected. The electronic endoscopy reporting database was used to compare case numbers of BBS in our Trust in years when Corflo and Freka PEG tubes were used, respectively. Data from our Trust were also compared with that from a Trust using Corflo only.

Results Fifty-eight cases of BBS were reported in the area covered by the Birmingham community nutrition team between 2009 and 2013, all of which were associated with Freka PEG tubes. An estimated 1000–1200 PEGs were inserted during this period, representing an incidence of BBS of 4.8–5.8%. No cases of BBS occurred over the same period in the comparison Trust (451 Corflo PEGs inserted).

Conclusions Our review confirmed our observation of an increased risk of BBS with Freka PEG tubes. Clinicians should be aware of our findings when deciding which brand of PEG tube to insert, particularly in patients with a previous history of BBS.


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