Treatment of the Buried Bumper Syndrome​​​​​: A Retrospective Multicenter Study With Inclusion of 160 Cases.

Background and goals: The therapy of buried bumper syndrome (BBS) is difficult. The aim of this retrospective multicenter study was to analyze the treatment methods with focus on effectiveness and safety of endoscopic techniques.

Methods: The analysis of all therapies and a comparison of the papillotome technique (PT) and needle knife-based nonpapillotome technique (NPT) were performed. Primary endpoint was technical success in one session, secondary endpoints overall technical success, number and duration of treatment sessions, SAE, and mortality.

Results: The primary treatment of 160 BBS cases, diagnosed between 2003 and 2021, was NPT in 60 (37.5%), PT in 43 (26.9%), push/pull technique (PPT) in 40 (25.0%), no removal in 9 (5.6%), laparotomy in 7 (4.4%) cases, and external incision in 1 (0.6%) case. For PT and NPT rates of technical success in one session were 95.5% and 45.0% (P<0.01), rates of overall technical success 100% and 88.3% (P=0.02), and mean number and duration of treatment sessions 1.05 (±0.21) versus 1.70 (±0.91) (P<0.01) and 32.17 (±21.73) versus 98,00 (±62.28) minutes (P<0.01), respectively. No significant differences between PT and NPT were found for SAE (15.9% vs. 25.0%) and mortality (2.3% vs. 1.7%). For PPT, laparotomy and external incision rates of technical success in one session and overall technical success were 100%, rates of SAE 2.5%, 50.0%, and 0% and mortality 0%, 10.0%, and 0%.

Conclusions: Endoscopic therapy of BBS is treatment of choice in most cases with removal of incomplete BB by PPT. In case of complete BB PT appears more effective than NPT.