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Introduction Buried bumper syndrome (BBS) is a rare (up to 2.5%) 1 complication of percutaneous endoscopic gastrostomy (PEG) in which the internal bumper migrates from the gastric lumen, becoming embedded in the gastric wall with PEG lumen becoming obstructed from subsequent mucosal overgrowth. This can result in abdominal pain, tube leakage, site breakdown and infection. Multiple endoscopic removal techniques have been described with varying success and complication rates, and the optimal procedure remains unclear. We present our experience using a combination of balloon dilatation of the gastrostomy tract and mucosal incision using a wire-guided sphincterotome under direct endoscopic vision; the tube is subsequently pushed into the stomach, removed orally and a new balloon gastrostomy placed into the existing tract.Methods A retrospective notes review and data collection of all patients referred to our Nutrition team with clinical BBS from 2022 to 2025 was performed. We aimed to determine the success and adverse event (AE) rates in our population.Results 15 patients were referred with BBS. All had CT imaging which was reviewed pre-procedure to ensure no anatomical contraindications. 2 were deemed inappropriate due to comorbidity, 2 were referred directly for surgical removal after imaging review and 11 underwent endoscopic removal. The median age was 52 years (range 32-62), 7 (64%) were male, 2 (18%) were on anticoagulants. 100% of buried PEGs were Freka tubes. Endoscopic removal was successful in 11 (100%). 3 (27%) were removed with tract dilatation alone, 8 (73%) required incision with wire-guided sphincterotome (ERBE Endocut I, effect 2, duration 2, interval 2), with a median of 2 (1-3) incisions required to free the bumper. 10 needed replacement balloon gastrostomies, 9 (90%) were successfully placed during the same procedure. Median procedure time was 25 minutes (range 12-45), median midazolam and fentanyl doses were 2 mg (0.5-3 mg) and 50 mcg (50-100 mcg) respectively, 3 required propofol. Bleeding occurred in 1 (9%) case which was treated endoscopically without the need for transfusion. No other AEs occurred; none required full general anaesthesia (GA) or repeat endoscopies. Median follow-up was 903 days (40-1405).Conclusions The technique utilised at our institution, in combination with careful radiological and clinical assessment, has high success rates with a low AE rate and a short procedure time. This avoids the need for GA or a further endoscopy to insert a new PEG in a comorbid and high-risk population. Further study from multiple centres to increase the sample size, as well as comparisons to other techniques, is required.Reference Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc 2023;15:44–55. https://doi.org/10.4253/wjge.v15.i2.44.