Solved on SIR Connect


By Avi Beck, MD, Jackson Bennett, MD, Mithil B. Pandi, DO, and Sudhen B. Desai, MD, FSIR


Gastropexy suture/disc follow-up after primary gastrostomy/ gastrojejunostomy placement


This column summarizes patient cases posted to SIR Connect (SIR’s popular online member community), the responses from other SIR members and how that feedback helped the original poster. To see how SIR’s online community can help you, visit SIR Connect at connect.sirweb.org


Original post, lightly edited for flow: bit.ly/2XkdRpR


Our IR section is having a discussion regarding follow-up of patients who have had primary gastrostomy/ gastrojejunostomy catheter placements using button-type gastropexy sutures. The buttons are supposed to fall off on their own over the period of a few weeks, but there are reports that these buttons can stay on the skin surface for longer than 3–4 weeks.


In practices where you use these gastropexy sutures, what are your practices for follow-up for these patients (if any), and why?


What challenges have you faced in following up on gastrostomy/ GJ catheters placed in patients with gastropexy sutures? A fair percentage of patients who have gastrostomy/GJ catheters placed by our service have socioeconomic or logistical issues that make follow-up difficult, sometimes requiring an inordinate amount of coordination, time, effort and cost.


Prior to development of our outpatient clinic at my former practice, follow-up was essentially dependent on the performing physician, which was prone to interoperator variability.


Patients have variable levels of care at home or in nursing facilities, which creates variability in how the


36 IRQ | SUMMER 2020


Author name and contact information Avi Beck, MD, Cleveland Clinic, Imaging Institute, becka6@ccf.org


Author background and current practice preferences for managing gastropexy suture follow-up I completed my residency at the Albany Medical Center in Albany, New York, followed by a 1-year imaging sciences training program fellowship focusing on translational research in IR at the National Institutes of Health. I then completed a 1-year vascular and interventional radiology fellowship at the Georgetown University Hospital program.


During residency and fellowship, our practice was to evaluate patients after 2 weeks for removal of gastropexy sutures and presence or absence of complications.


After completing fellowship, I worked for 8 years in a mid-sized private practice radiology group in a small metropolitan region with multiple hospital sites. Our IR section’s practice was to follow-up with patients 2 weeks after primary placement of gastrostomy or gastrojejunostomy (GJ) placement.


We used button-type gastropexy sutures. I typically placed three sutures and locked the buttons tight enough to the skin surface to create a strong hold, but not so tight that skin ulceration would be likely. The patient was scheduled for a walk-in visit to remove the sutures. If the sutures had fallen off and the feeding tube was working properly, the patient did not have to come in for evaluation. After several years, our practice created a formal IR outpatient clinic/office, which became the preferred method of follow-up for these patients.


In July 2019, I joined the team at Cleveland Clinic, an academic practice serving a main campus and multiple satellite regional hospitals (which function more similarly to a private practice-type/community hospital model). Since joining this team, I have continued to ask that the patients be scheduled for a 2-week follow-up in our IR outpatient clinic at the main campus (similar to my prior practice).


catheters are maintained as well as in the threshold for calling our team with potential issues such as excessive leakage, signs of infection or ulceration.


What specifically prompted you to reach out regarding this case/topic? After moving to my new job, I noticed that my practice of bringing these patients back for follow-up did not align with the existing practice, developed


with the notion that the gastropexy sutures we use absorb and the discs fall off spontaneously without complication.


With the emergence of the COVID-19 pandemic, additional discretionary measures are being implemented, causing us to scrutinize every outpatient visit.


After discussing management of enteral access patients, it became clear to me that there was variation in follow-up,


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