Observed high incidence of buried bumper syndrome associated with Freka PEG tubes.

BACKGROUND: Buried bumper syndrome (BBS) is an uncommon but significant complication of percutaneous endoscopic gastrostomy (PEG), which occurs due to overgrowth of gastric mucosa over the inner bumper of the gastrostomy tube. A high incidence of BBS was observed in patients with Freka PEG tubes. OBJECTIVE: To review case numbers of BBS and confirm the observed association with Freka tubes to determine whether change of practice should be considered. DESIGN: Data was collected on the number of cases of BBS reported to the community nutrition team Birmingham, UK. Data on type of PEG kit and total number of PEGs inserted between 2009 and 2013 were collected. The electronic endoscopy reporting database was used to compare case numbers of BBS in our Trust in years when Corflo and Freka PEG tubes were used, respectively. Data from our Trust were also compared with that from a Trust using Corflo only. RESULTS: Fifty-eight cases of BBS were reported in the area covered by the Birmingham community nutrition team between 2009 and 2013, all of which were associated with Freka PEG tubes. An estimated 1000-1200 PEGs were inserted during this period, representing an incidence of BBS of 4.8-5.8%. No cases of BBS occurred over the same period in the comparison Trust (451 Corflo PEGs inserted). CONCLUSIONS: Our review confirmed our observation of an increased risk of BBS with Freka PEG tubes. Clinicians should be aware of our findings when deciding which brand of PEG tube to insert, particularly in patients with a previous history of BBS.

Review of surgical management of cystic hydatid disease in a resource limited setting: Turkana, Kenya.

OBJECTIVE: Cystic hydatid disease is a zoonotic infection of humans caused by infection with the larval stage of Echinococcus granulosus. The prevalence rate (5-10%) in Turkana, Northern Kenya is among the highest worldwide. With an increase in foreign travel and migration of peoples, practitioners need to be aware of diseases common in these countries and their rarer manifestations. The objective of this study was to review the management of this disease in a poorly resourced high-prevalence area. METHODS: The surgical records of Kakuma Mission Hospital, Turkana from July 1981 to May 2002 were reviewed. RESULTS: A total of 710 (female : male, 3 : 2) surgical procedures for hydatid disease were recorded, the average age being 27 years (range, 3-65 years). There were 663 patients, and therefore 47 patients had repeat procedures. A total of 52.8% (n = 375) had hepatic cysts (248 right sided, 30 left sided, 97 site undefined), and 10.1% (n = 72) had multiple abdominal cysts. Other intra-abdominal sites included 8.16% mesenteric (n = 58), 2.9% retroperitoneal (n = 21), 3.5% spleen (n = 25), the abdominal wall (n = 4). There was no information on the site of disease in 5.9% of cases (n = 42). More unusual sites were retro-orbital, gluteal, zygomatic, brachial, parotid, uterine, tibial and foot. The largest volume of cyst fluid was 7 l. There was one intraoperative death and one postoperative death recorded. Endocystectomy +/- a scolicidal was the commonest procedure performed. However, 165 percutaneous aspiration injection of a scolicidal agent and reaspiration procedures were performed, six being on pregnant women. This is one of the largest series of surgical hydatid patients from Africa and demonstrates the wide diversity in cyst location.

Outcome measurement in clinical trials for Ulcerative Colitis: towards standardisation.

Clinical trials on novel drug therapies require clear criteria for patient selection and agreed definitions of disease remission. This principle has been successfully applied in the field of rheumatology where agreed disease scoring systems have allowed multi-centre collaborations and facilitated audit across treatment centres. Unfortunately in ulcerative colitis this consensus is lacking. Thirteen scoring systems have been developed but none have been properly validated. Most trials choose different endpoints and activity indices, making comparison of results from different trials extremely difficult. International consensus on endoscopic, clinical and histological scoring systems is essential as these are the key components used to determine entry criteria and outcome measurements in clinical trials on ulcerative colitis. With multiple new therapies under development, there is a pressing need for consensus to be reached.