Intended for healthcare professionals

Rapid response to:

Clinical Review

Percutaneous endoscopic gastrostomy (PEG) feeding

BMJ 2010; 340 doi: (Published 07 May 2010) Cite this as: BMJ 2010;340:c2414

Rapid Response:

Preventing buried bumper syndrome

Kurien et al. correctly identify buried bumper syndrome as an
important complication of percutaneous endoscopic gastrostomy (PEG)
insertion. Unfortunately they do not outline the instructions that should
be given to patients and/or their carers which are thought to prevent this
occurring (1).

We believe that these instructions are important to all practitioners
involved in the care of these patients. The correct instructions are as
Once the stoma tract is mature (approximately 3 weeks post insertion), the
external skin fixator should be loosened once-weekly, the PEG tube should
be rotated one full-turn and advanced a few centimetres into the stoma
tract. The PEG tube should then be withdrawn until the internal bumper is
felt to rest against the gastric wall and the skin fixator replaced.

If the PEG tube cannot be rotated or advanced within the stoma tract,
buried bumper syndrome should be suspected and review by the local
nutrition team arranged.

Reference List

(1) Foutch PG, Talbert GA, Waring JP et al. Percutaneous endoscopic
gastrostomy in patients with prior abdominal surgery: virtues of the safe
tract. Am J Gastroenterol 1988;83(2):147-50.

Competing interests:
None declared

Competing interests: No competing interests

19 May 2010
Ruchi Bhalla
Foundation year 2 doctor, Department of Medicine.
Simon D McLaughlin, Gastroenterology Specialist Registrar
Conquest Hospital, St. Leonards-on-sea, TN37 7RD