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SIR 2025

Gastrointestinal Interventions

Scientific Session

Session: General IR 1

Long-Term Migratory Patterns of T-Fastener Anchors Post G-Tube Insertion: A Retrospective Review

Monday, March 31, 2025
3:54 PM – 4:03 PM CT
Location: Music City Center, 207 CD
Purpose: T-fasteners are used in most percutaneous gastrostomy tube (G-tube) procedures performed in the US. Complications related to entry-site infection have been mitigated using an absorbable suture. Still, the anchoring component of the T-fastener is not absorbable and can end up in a variety of places.

Materials and Methods: Single-center retrospective review of patients who received G-tube insertion with T-fastener gastropexy and subsequent cross-sectional imaging after G-tube insertion from August 2016 to December 2023. Post-placement images (CT Abdomen, CT Chest, FDG PET/CT) were reviewed to determine the T-fasteners' location at various time points following G-tube insertion, when available. Variable locations were noted, though most commonly the anchors were observed to 1) Disappear into the GI tract as designed, 2) Remain embedded in the peritoneal lining/rectus, and 3) Remain embedded in the gastric mucosa. Patient charts were reviewed for any mention of problems with the G-tube or T-fasteners.

Results: This study included 135 patients who had undergone percutaneous G-tube placement using T-fastener gastropexy and subsequent post-procedure cross-sectional imaging. The mean number of T-fasteners used per procedure was 2.4. 56% of patients (75/135) were noted to have at least 1 retained T-fastener anchor on subsequent cross-sectional imaging. The total number of visualized retained anchors was 129. Of the retained anchors, 68 were retained at the level of the peritoneal lining; 54 were in the gastric mucosae. Patients who had 3 T-fasteners placed originally were 44% less likely to have a retained anchor on subsequent imaging (p=0.018). Complications, instances wherein subsequent imaging was obtained to evaluate for G-tube malfunction within a 30-day interval, were observed in 3 of these patients, and only one had retained T-fasteners due to accidental G-tube removal by the patient’s family (per chart). No complications or complaints attributed to retained T-fastener anchors were seen from the patient records with no mention of retained T-fastener anchors appreciated in the follow-up cross-sectional imaging.

Conclusion: These results suggest that T-fastener anchors pose no serious threat of complication or complaint when not passed into the enteric system as originally intended. It appears using more T-fastener anchors during G-tube placement is associated with a lower likelihood of becoming embedded in gastric mucosa or peritoneum, which may be due to the increased tension applied to the fasteners when 2 fasteners are used instead of 3, though further evaluation is needed.