Letters To The Editor
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2017; 23(35): 6546-6548
Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6546
Novel endoscopic management of buried bumper syndrome in percutaneous endoscopic gastrostomy: The Olympus HookKnife
Laura E Wolpert, Dominic M Summers, Andrew Tsang
Laura E Wolpert, Dominic M Summers, Andrew Tsang, Department of General Surgery, Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough PE3 9GZ, United Kingdom
Author contributions: Wolpert LE wrote the letter; Summers DM and Tsang A revised the letter.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Laura E Wolpert, BM BCh, Doctor, Department of General Surgery, Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough PE3 9GZ, United Kingdom. laura@wolperts.com
Telephone: +44-7733-678000 Fax: +44-1733-677618
Received: June 16, 2017
Peer-review started: June 19, 2017
First decision: July 17, 2017
Revised: July 31, 2017
Accepted: August 25, 2017
Article in press: August 25, 2017
Published online: September 21, 2017
Abstract

Buried bumper syndrome (BBS) is an uncommon but serious complication of percutaneous endoscopic ga-strostomy. It involves the internal fixation device, or “bumper”, migrating into the gastric wall and subsequent mucosal overgrowth. We described a case series of four patients with BBS treated with a novel endoscopic technique using a HookKnife between June 2016 and February 2017. The HookKnife is a rotating L-shaped cutting wire designed for hooking tissue and pulling it away from the gastric wall towards the lumen. The technique was successful in all four cases with no complications. Each patient was discharged on the day of treatment. The HookKnife is a manoeuvrable, safe and effective device for endoscopic removal of buried bumpers and could avoid surgery in a high risk group of patients. To our knowledge this technique has not been described previously. We suggest that this technique should be added to the treatment algorithms for managing BBS.

Keywords: Buried bumper syndrome, Percutaneous endoscopic gastrostomy, HookKnife

Core tip: This letter to the editor describes a case series of four patients who underwent a novel endoscopic technique for managing buried bumper syndrome using the Olympus HookKnife. This technique was successful in all four patients and no complications were recorded. We propose that this technique may be a safe and effective treatment for buried bumper syndrome in percutaneous endoscopic gastrostomy feeding.