Spectrum of morbidity related to bolster placement at time of percutaneous endoscopic gastrostomy: buried bumper syndrome to leakage and peritonitis.

Setting the external bolster at the time of placement of percutaneous endoscopic gastrostomy (PEG) is a key factor in the spectrum of morbidity and complications related to the procedure. Setting the bolster too tight results in various gradations of buried bumper syndrome, whereas setting the bolster too loose can lead to leakage and acute peritonitis. Aspects of the initial technique, awareness of contributing factors, and strategies for monitoring and surveillance of the PEG once placed are all important in preventing more serious sequelae.