Buried bumper syndrome (BBS) is a complication affecting individuals with long-term gastrostomy feeding tubes, particularly percutaneous endoscopic gastrostomy (PEG) tubes. It occurs when the internal anchor, often called a “bumper,” of the feeding tube migrates. Instead of remaining freely inside the stomach, the bumper becomes embedded within the stomach or abdominal wall. This embedding can lead to various issues.
Causes of Buried Bumper Syndrome
The primary reason BBS develops is excessive pressure between the internal bumper and the external bolster on the skin. When the external bolster, which secures the tube, is tightened too much against the skin, it creates constant inward pressure. This sustained compression can cause the internal bumper to gradually erode into the gastric or abdominal wall.
Several factors contribute to this increased pressure and the risk of bumper embedding. Significant weight gain after tube placement can increase abdominal wall thickness, pulling the skin tighter against the external bolster and increasing tension on the internal bumper. Poor initial placement of the tube, where the tract is too tight or the tube is inserted at an improper angle, can also predispose individuals. Inadequate routine tube care, such as not regularly adjusting the external bolster, further contributes.
Some specific tube designs might also present a slightly higher risk for bumper embedding due to their material or shape, though this is less common than issues related to external pressure. This persistent mechanical stress gradually leads to the internal bumper becoming encased in tissue.
Symptoms and Diagnosis
Recognizing the signs of buried bumper syndrome is important for individuals with PEG tubes and caregivers. Common indications include new or worsening pain at the tube site, particularly noticeable during feeding or flushing. Leakage of stomach contents or digestive fluids around the tube site is another frequent symptom, often indicating the seal around the tube has been compromised. An inability to infuse feeds or flush the tube effectively, or encountering resistance, suggests an obstruction or misplacement of the internal bumper.
A significant diagnostic clue is the inability to gently rotate or move the tube in and out of the stoma, often called “pistoning.” Normally, a PEG tube should have a small degree of mobility; its immobility suggests the internal bumper is no longer free within the stomach. When a healthcare provider suspects buried bumper syndrome, they typically begin with a physical examination of the tube site to assess for tenderness, swelling, or leakage.
Confirmation of the diagnosis often involves an endoscopic examination. During this procedure, a thin, flexible tube with a camera is inserted into the stomach to visualize the internal bumper’s position. This allows the medical team to determine if the bumper has migrated and become embedded in the stomach wall, confirming buried bumper syndrome.
Treatment Approaches
Once buried bumper syndrome is diagnosed, treatment almost always requires removal of the affected feeding tube. The method of removal depends largely on how deeply the internal bumper is embedded. In some cases, if the embedment is not severe, non-invasive endoscopic techniques may be used. This can include methods like the “push-pull” technique, where the tube is gently manipulated, or using a guidewire to dislodge the bumper from the tissue.
For more deeply embedded bumpers, a more involved endoscopic approach may be necessary, sometimes requiring specialized tools to free the bumper from the surrounding tissue. If the bumper is extensively or completely embedded within the abdominal wall, surgical intervention may be required to safely remove the tube. This more invasive procedure ensures complete removal of the buried component and addresses any associated complications.
Following successful removal of the buried tube, a new feeding tube is typically placed. This new tube is usually inserted in a different location on the abdominal wall to allow the previously affected site to heal. The placement of a new tube ensures that the patient can continue to receive necessary nutritional support without interruption.
Prevention Techniques
Preventing buried bumper syndrome involves diligent care of the gastrostomy tube. A primary preventive measure is ensuring the external bolster is not positioned too tightly against the skin. Healthcare providers generally recommend leaving a few millimeters of space between the bolster and the skin to prevent excessive pressure on the internal bumper. This gap allows for slight movement and reduces the risk of the bumper eroding into the stomach wall.
Daily care routines are also important for prevention. This includes regularly cleaning the tube site to prevent infection and assessing the skin around the stoma. Performing the “push and turn” maneuver, as instructed by a medical professional, is an effective technique. This involves gently pushing the tube inward and then rotating it 360 degrees to confirm the internal bumper is freely moving within the stomach.
Regular follow-up appointments with a healthcare provider are beneficial for monitoring the tube’s position and condition. These visits are important after any significant changes in the patient’s weight, as weight fluctuations can alter the tension on the tube and increase the risk of bumper embedding. Adherence to these preventive strategies helps maintain the tube’s proper function and reduces the likelihood of buried bumper syndrome.