PT  - JOURNAL ARTICLE
AU  - Angus Kitchin
AU  - Wolf-Rudiger Matull
AU  - Daniel Pearl
TI  - Buried bumper syndrome: improving patient outcomes using a structured multidisciplinary team (MDT) approach to management
AID  - 10.1136/flgastro-2021-102070
DP  - 2022 Apr 10
TA  - Frontline Gastroenterology
PG  - flgastro-2021-102070
4099  - http://fg.bmj.com/content/early/2022/04/10/flgastro-2021-102070.short
4100  - http://fg.bmj.com/content/early/2022/04/10/flgastro-2021-102070.full
AB  - Introduction Buried bumper syndrome (BBS) is a complication seen in 2.4% of percutaneous endoscopic gastrostomy (PEG) tubes. We present a case series of 30 patients with BBS managed at a regional referral centre over 13 years.Methods The original pioneering service (2007–2013) involved sporadic management by various endoscopists or surgeons (group A). More recently (2014–2020), patients with endoscopic or clinically suspected BBS were referred to a specialist multidisciplinary team (MDT) clinic, facilitating a best interest approach to decision making (group B). The objective of this MDT clinic is to plan for an interventional endoscopic procedure under general anaesthesia (GA) with balloon assisted PEG manipulation±needle-knife excision aiming for successful endoscopic feeding tube (FT) replacement through the established tract.Results Results are expressed as group B (n=19) vs group A (n=11). Statistical analysis used Fisher’s exact and unpaired t-tests. In group B, less patients required surgery to replace their FT (1 (5.3 %) vs 4 (36.4 %), p<0.05), more FTs were replaced in the pre-existing tract (18 (94.7 %) vs 2 (18.2 %), p<0.001), mean length of stay (LOS) was shorter (4.2 vs 10.5 days, p<0.05) and there were fewer complications (2 (10.5 %) vs 4 (36.4 %), p=0.16). Overall, endoscopic versus surgical management was associated with a shorter LOS (5.3 vs 12 days, p<0.05).Conclusion Nuanced decision making as part of a dedicated BBS service, employing MDT decision making and a structured management approach, is associated with improved patient outcomes.Data may be obtained from a third party and are not publicly available. A confidential database listing patient hospital numbers and procedural information is stored on the trust account.