Ganesh Krishnamurthy MBBS, Abstract Co-Author: Nothing to Disclose

Bairbre Louise Connolly MD, Presenter: Nothing to Disclose

Dimitri Alejandro Parra MD, Abstract Co-Author: Nothing to Disclose

Joao Guilherme Amaral MD, Abstract Co-Author: Nothing to Disclose

Philip John MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

Michael John Temple MD, Abstract Co-Author: Nothing to Disclose

Conor Oilver Bogue MBBCh, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Retention anchor sutures (RAS) are commonly used during image guided percutaneous enterostomy access, to oppose the bowel/gastric wall to the abdominal wall. The RAS is a fine metal bar with attached thread. The thread is cut at 2 weeks, and is assumed to pass with the luminal contents. However the metal bar may not pass, is ferromagnetic, moves in 1.5 & 3T magnets, and causes image artifact. We experienced a child who developed site pain and extrusion of the RAS through her G-Tube tract after MRI. This prompted us to study the fate of the RAS in pediatric patients following G-Tube insertion, to determine the timing of RAS passage and incidence of complications, and the implications for MR safety.

REB approval was obtained. Patients undergoing image guided G-Tube insertions between 2004-2006 were identified. Any imaging covering the area of the G-Tube & RAS was reviewed. Normal passage was defined as RAS gone by 4 weeks after insertion. Passage later than 4 completed weeks post insertion was defined as delayed. The fate of the RAS was determined.

483 children underwent G-Tube insertion between `04-`06. There was no follow-up imaging in 51. In the remaining 432 patients, 30 showed the RAS present 4 weeks after insertion (7%). 7/30 required the RAS to be removed by interventional radiology (6 from within the tract by forceps, 1 from the gastric lumen by snare) at 6-68 weeks post insertion (mean 29 weeks). 11/30 showed delayed passage of the RAS at 5-77 weeks post insertion (mean 27 weeks). 12/30 showed the RAS still present on the most recent images from this institution (taken 1 month – 2.8 years ago) at 5 - 147 weeks post insertion (mean 48 weeks). Given the safety/imaging implications for MRI, an ‘Alert System’ was developed, and this is outlined.   Examples of unusual positions, removals, complications and symptomatic RAS are shown in this poster.

Delayed passage of the RAS occurs in at least 7% of patients, can be symptomatic and may require removal.

The presence of a metallic RAS has real implications for MR safety in children post G-Tube insertion.

Krishnamurthy, G, Connolly, B, Parra, D, Amaral, J, John, P, Temple, M, Bogue, C, et al, , Suture Anchors in Gastrostomy Tubes (G-Tubes): Fate, Complications, and Implications for MRI Safety.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6021244.html