Innovations In Treatment Of Buried Bumper Syndrome (BBS): The Balloon Dilation Pull (BDP) Technique: Pump It Up And Pull It Out!

Aims To demonstrate efficacy and safety of the BDP-technique for treatment of BBS and to present a modification of the technique in case of complete BBS.

Methods Monocentric retrospective study of consecutive BBS-patients treated with the BDP-technique between June 2019 and November 2020. Primary outcome measures were technical success rate, procedure time and occurrence of adverse events. In the first step of the BDP-technique, the PEG-tube is cut at the cutaneous side at 1-2cm. In case of complete BBS, a new entry site is made through the PEG-tube with a metal paracentesis needle. Subsequently, a guidewire is advanced into the stomach through the PEG-tube (or paracentesis needle sheath) and is grasped endoscopically with a snare. Thereafter, a dilation balloon (15-18mm) is advanced over the guidewire through the endoscope and through the PEG-tube. By inflating it to the maximum dilation pressure, the balloon stays solidly impacted into the buried bumper which is removed by traction on the endoscope and the balloon catheter together. If necessary, a new PEG-tube is inserted, which can be used immediately.

Results A total of 7 BBS-patients were treated with the BDP-technique with a mean age of 72 years (range 60-83). The procedures were performed under deep sedation in 6 patients. In 1 patient, in whom the anaesthetic risk was deemed very high, the procedure was performed without any form of sedation. The mean procedure time was 14,5 minutes (range 5-27). Technical success rate was 100 %. No direct post-procedure complications were seen. One episode of aspiration pneumonia was noted, rather as a complication of the patient’s underlying medical condition than due to the endoscopic procedure.

Conclusions The BDP-technique is a simple endoscopic procedure, using endoscopic accessories which are readily available in every endoscopic unit. The procedure time is short and the technical success rate is optimal without any immediate direct complications.

Citation Maly M, Snauwaert C eP150 INNOVATIONS IN TREATMENT OF BURIED BUMPER SYNDROME (BBS): THE BALLOON DILATION PULL (BDP) TECHNIQUE: PUMP IT UP AND PULL IT OUT!. Endoscopy 2021; 53: S145.

Publication History

Article published online:
19 March 2021