Minimal incision endoscopic PEG pull through (MIEPT) technique for buried bumper: first pediatric report

摘要

Abstract Purpose Buried bumper (BB) is a rare complication of percutaneous endoscopic gastrostomy (PEG). The minimal incision endoscopic PEG pull through (MIEPT) technique and outcome are reported.Methods All BB managed in January 2011–May 2021 were included. Under endoscopic vision, the PEG tube with BB is cut to facilitate passage of a guide-string into the stomach and brought out through the oral cavity. The tapered end of a new PEG tube is tied to the string and pulled back into the stomach against the flange of the original PEG. A minimal incision is made at skin and fascia levels to facilitate pull-through of both tubes using the original track, without mucosal disruption. The incision is sutured.Results Eight patients had BB treated with MIEPT at median age of 13 years (5–16). Median time from insertion to BB developing was 26 months (18–41). Follow-up was 36 months (3–39): time to full gastrostomy feed was 12 h (12–24) and time to discharge was 48 h (24–48 h). Recurrence of BB occurred in two. None had early postoperative complication.Conclusion MIEPT is an effective minimally invasive technique in children to avoid a laparotomy for BB, with the advantage of complete mucosal preservation which prevents leakage.