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PEG( percutaneous endoscopic gastrostomy) has become the procedure of choice for providing enteral access for nutritional support in adults with malnutrition. Although success rates greater than 95% have been reported for PEG, procedure-related complications are common e.g. leakage, infection, tube migration, buried bumper symptom etc.
Leakage from PEG site is not uncommon. It is caused by inappropriate tube size, fast feeding or large feeding volume etc. Actually, buried bumper syndrome is a major complication causing leakage which immediate management is required. The buried bumper syndrome is defined as migration of the PEG tube into the gastric wall and the subsequent epithelization of the ulcer site. Buried bumper arises from excessive traction on the tube causing it to burrow into the gastric wall. The common signs and symptoms are abdominal pain, leakage, difficulty feeding or flushing the tube; and inability to advance, withdraw or rotate the tube. Treatment involves removing the tube (which may require upper endoscopy), allowing the tract to close while an alternative method of feeding is established, and then placing a new PEG tube in a different location.
I received a few consultations about PEG leakage. During my assessment, I found that feeding rate and volume is normal and the tube size is fitted. However, a palpable area is felt around PEG site without any redness or discharge. Buried bumper syndrome was identified. Then a new tube was replaced by the doctor. Afterwards, no further leakage was detected.
As an enterostomal therapist, we are not just managed the complaint only. Accurate diagnosis making is crucial before any treatment in order to provide optimal nursing care and improve quality of life to our patient.
Leakage from PEG site is not uncommon. It is caused by inappropriate tube size, fast feeding or large feeding volume etc. Actually, buried bumper syndrome is a major complication causing leakage which immediate management is required. The buried bumper syndrome is defined as migration of the PEG tube into the gastric wall and the subsequent epithelization of the ulcer site. Buried bumper arises from excessive traction on the tube causing it to burrow into the gastric wall. The common signs and symptoms are abdominal pain, leakage, difficulty feeding or flushing the tube; and inability to advance, withdraw or rotate the tube. Treatment involves removing the tube (which may require upper endoscopy), allowing the tract to close while an alternative method of feeding is established, and then placing a new PEG tube in a different location.
I received a few consultations about PEG leakage. During my assessment, I found that feeding rate and volume is normal and the tube size is fitted. However, a palpable area is felt around PEG site without any redness or discharge. Buried bumper syndrome was identified. Then a new tube was replaced by the doctor. Afterwards, no further leakage was detected.
As an enterostomal therapist, we are not just managed the complaint only. Accurate diagnosis making is crucial before any treatment in order to provide optimal nursing care and improve quality of life to our patient.