Methods: A 55 year old female patient was diagnosed

with early GSI-IX manufacturer gastric cancer on screening endoscopy. Abdominal computed tomography showed incidental right renal cell carcinoma. Results: Robot assisted distal gastrectomy was performed followed by partial nephrectomy. Conclusion: Robot assisted combined operation could be a treatment option for early stage of synchronous malignancies. Key Word(s): 1. gastric cancer; 2. robot assisted gastrectomy; 3. robot assisted nephrectomy Presenting Author: DEWI NORWANI BASIR Additional Authors: WAI LEONG QUAN Corresponding Author: DEWI NORWANI BASIR Affiliations: Tan Tock Seng Hospital Objective: Buried Bumper Syndrome is a known but uncommon complication in patients with Percutaneous Endoscopic Gastrostomy (PEG) tubes. We describe an elderly man with a background of laryngeal cancer with post radiotherapy swallowing impairment. He also had stomach cancer with Billroth II gastrectomy performed previously. A Percutaneous Endoscopic Jejunostomy (PEJ) tube was recently inserted because of a persistently misplaced nasogastric tube.

It was placed through the jejunal wall due to altered anatomy with no other suitable sites found. Patient presented with a blocked tube and was referred for endoscopic re-evaluation and change of PEJ tube. Methods: On endoscopy, a small punctum located at the site where the internal bumper was expected to be was identified. This finding is diagnostic of a complete buried bumper syndrome. We proceeded Autophagy Compound Library with the one step pull through method to remove and replace the PEJ tube at the same time. The PEJ tube was cut approximately 2 to 3 cm from the skin and an ordinary PEG trocar was inserted through the cut end of the PEJ tube into the stomach under endoscopic view. The trocar was removed leaving the white sheath in place. We then inserted the

blue nylon string through the white sheath into the stomach in the usual manner. The string was then captured with a snare and pulled out through very patient’s mouth. Results: Once outside the body, a new PEG tube was attached to the nylon string the usual manner and gently pulled back into the stomach. The tapering plastic end of the new tube was made to push against the buried bumper which forced it to exit through the skin while the new tube was pulled into position. This one step pull through method not only removed the buried bumper syndrome but also replaced the PEJ tube at the same time thereby minimising the risk of peritoneal leak. The final position of the new PEJ tube appeared satisfactory endoscopically. Conclusion: The 1 step pull through method is simple and safe to perform. No new incision is needed and the removal and reinsertion of PEG/PEJ tube can be performed at the same setting. Key Word(s): 1. buried bumper syndrome; 2.