The 'buried bumper syndrome': A complication of percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy is used for long-term nutritional support and can be performed with relatively few complications. We describe a patient in whom the internal bumper eroded into the stomach wall and was completely covered by gastric epithelium 11 months after gastrostomy tube placement. The gastrostomy tube itself was patent, and the end still protruded into the lumen of the stomach so that tube feeding was not impaired. Endoscopy, in combination with passage of Savary dilators over a guidewire, was safely used to remove the gastrostomy tube and buried bumper. We recommend this approach in patients with the 'buried bumper' syndrome to prevent continued tube migration into the gastric and abdominal walls.