Novel endoscopic management of buried bumper syndrome in percutaneous endoscopic gastrostomy: The Olympus HookKnife

Figure 1 The Olympus HookKnife[2]-A rotating L-shaped cutting wire designed to hook mucosal tissue and pull it towards the lumen. It was originally designed for use in colonic polypectomies. In Oyama et al[3] the HookKnife was deployed to resect lymph node metastases of gastric and oeseophageal mucosal cancers.

Figure 2 Endoscopic removal of a buried percutaneous endoscopic gastrostomy bumper using the HookKnife technique. A: Visualisation of the buried bumper. The gastric mucosa has overgrown the internal percutaneous endoscopic gastrostomy (PEG) fixation device leaving a small mucosal orifice. A through-the-scope balloon can be used to dilate the mucosal orifice; B: View of the Olympus HookKnife being deployed. Radial incisions are made by hooking the gastric mucosa and pulling it towards the lumen; C: A through-the-scope balloon has been inserted externally to stiffen the PEG system. Pressure is applied to the balloon to force the bumper into the lumen.