Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy

Table 1 Buried bumper syndrome severity classification (adapted from[90])

Grade	Finding			Action
	Clinical (cannula)	Endoscopical	Radiological
0	Movable patent	Normal	Not needed	Prevention
1	Movable patent	Ulcer below the disc and/or marginal overgrowth1 (less than half of the disc area covered)	Not needed	Prevention/follow-up
2	Mostly fixed mostly patent	Disc2 components still visible1 (more than half of the disc area covered)	Not needed	Endoscopy w/o dissection
3	Fixed might be patent	Disc2 completely covered1	Disc localised inside the stomach	Endoscopy with dissection
4	Fixed mostly blocked	Disc2 completely covered1	Disc localised outside the stomach	Surgery
5	Disc protrudes out of the skin or palpable just below the skin1	Disc2 completely covered	Not needed	Surgery/extraction

¹Disc represents all the internal part of the cannula including possible central knob;

²Critical components of the classification.