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Spanaki C, Boura I, Avgoustaki A, et al. Buried Bumper Syndrome: A common complication of levodopa intestinal infusion for Parkinson disease. Parkinsonism Relat Disord. 2021;85:59-62doi: 10.1016/j.parkreldis.2021.02.032.
Spanaki, C., Boura, I., Avgoustaki, A., Orfanoudaki, E., Giannopoulou, I. A., Giakoumakis, E., Chlouverakis, G., Athanasakis, E., & Koulentaki, M. (2021). Buried Bumper Syndrome: A common complication of levodopa intestinal infusion for Parkinson disease. Parkinsonism & related disorders, 8559-62. https://doi.org/10.1016/j.parkreldis.2021.02.032
Spanaki, Cleanthe, et al. "Buried Bumper Syndrome: A common complication of levodopa intestinal infusion for Parkinson disease." Parkinsonism & related disorders vol. 85 (2021): 59-62. doi: https://doi.org/10.1016/j.parkreldis.2021.02.032
Spanaki C, Boura I, Avgoustaki A, Orfanoudaki E, Giannopoulou IA, Giakoumakis E, Chlouverakis G, Athanasakis E, Koulentaki M. Buried Bumper Syndrome: A common complication of levodopa intestinal infusion for Parkinson disease. Parkinsonism Relat Disord. 2021 Apr;85:59-62. doi: 10.1016/j.parkreldis.2021.02.032. Epub 2021 Mar 12. PMID: 33743506.
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Parkinsonism Relat Disord. 2021 Apr;85:59-62. doi: 10.1016/j.parkreldis.2021.02.032. Epub 2021 Mar 12.

Buried Bumper Syndrome: A common complication of levodopa intestinal infusion for Parkinson disease.

Parkinsonism & related disorders

Cleanthe Spanaki, Iro Boura, Aikaterini Avgoustaki, Eleni Orfanoudaki, Irene Areti Giannopoulou, Emmanouil Giakoumakis, Gregory Chlouverakis, Elias Athanasakis, Mairi Koulentaki

Affiliations

  1. Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; University of Crete, School of Medicine, Voutes University Campus, Heraklion, 70013, Crete, Greece. Electronic address: [email protected].
  2. Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; University of Crete, School of Medicine, Voutes University Campus, Heraklion, 70013, Crete, Greece.
  3. Department of Gastroenterology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece.
  4. Department of Gastroenterology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece; Department of Gastroenterology, General Hospital of Chania, Mournies, 73300, Chania, Crete, Greece.
  5. Department of Neurology, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece.
  6. Department of Social Medicine, Biostatistics Lab, School of Medicine, University of Crete, Voutes Place, 71500, Heraklion, Crete, Greece.
  7. Department of General Surgery, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece.

PMID: 33743506 DOI: 10.1016/j.parkreldis.2021.02.032

Abstract

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is required for Levodopa/Carbidopa Intestinal Gel (LCIG) delivery in patients with advanced Parkinson's disease (PD) as well as for enteral feeding in a variety of neurological disorders. Buried Bumper Syndrome (BBS) is a serious complication of PEG. The frequency of BBS in patients receiving LCIG treatment has never been reported.

OBJECTIVES: To compare the frequency of BBS in patients on LCIG treatment or on enteral feeding over the past 12 years and identify possible risk factors.

METHODS: We reviewed prospectively recorded data from 2009 to 2020 on two case-series: LCIG-treated PD patients and non-PD patients on enteral nutrition. We identified all BBS incidences. Patients' characteristics, clinical manifestations, BBS management, possible risk factors and outcomes were analyzed.

RESULTS: During the 12 years, 35 PD patients underwent PEG insertion for LCIG infusion, and 123 non-PD patients for nutritional support. There were eight cases of BBS in six PD patients (17.1%). Six of them were effectively managed without treatment discontinuation. Of the enteral feeding patients, only one developed BBS (0.8%) (p < 0.001). We identified inappropriate PEG site aftercare, weight gain, early onset PD, longer survival, treatment duration, dementia and PEG system design as potential risk factors for BBS development.

CONCLUSIONS: BBS occurs more frequently in LCIG patients than in patients receiving enteral feeding. If detected early, it can be successfully managed, and serious sequalae or treatment discontinuation can be avoided. Regular endoscopic follow-up visits of LCIG-treated patients and increased awareness in patients and clinicians are recommended.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Keywords: Adverse event; Buried bumper syndrome; Carbidopa intestinal gel; Case series; Levodopa; Parkinson's disease; Percutaneous endoscopic gastrostomy

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