Cope Gastrointestinal Suture Anchor Set

Added Jun 4, 2008

Manufactured by Cook Medical

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Reviewed by Dr Dominic Fay Reviewed Aug 24, 2010

Consultant Interventional Radiologist,Royal United Hospitals, Bath, UK - No Conflict Declared

Editor Rating

The Cope Gastrointestinal Suture Anchor Set is a venerable but effective gastropexy device best suited for use during the placement of retaining loop gastrostomies. The anchor itself is fashioned from a 2cm section of flexible guidewire, with a suture attached centrally. This flexibility theoretically causes reduced local gastric trauma when the anchor is tensioned. The kit contains a 12cm 17G cutting needle with one anchor preloaded, a 75cm mandril guidewire which tapers from a 0.035in flexible tip to a narrow monofilament shaft and a second anchor which may be loaded into the needle if a second gastropexy is required.

 

Introduction

The Cope Gastrointestinal Suture Anchor Set is a venerable but effective gastropexy device best suited for use during the placement of retaining loop gastrostomies. The anchor itself is fashioned from a 2cm section of flexible guidewire, with a suture attached centrally. This flexibility theoretically causes reduced local gastric trauma when the anchor is tensioned. The kit contains a 12cm 17G cutting needle with one anchor preloaded, a 75cm mandril guidewire which tapers from a 0.035in flexible tip to a narrow monofilament shaft and a second anchor which may be loaded into the needle if a second gastropexy is required. 

 

In use

The stomach is punctured with the needle containing a preloaded anchor and once positioning is confirmed (it is possible to aspirate gas or inject contrast past the preloaded anchor) the guidewire is passed through the needle into the gastric lumen dislodging the anchor. The needle can then be removed over the suture and guidewire leaving the anchor and guidewire in situ and tension can be placed on the suture to provide robust fixation during tract dilatation and tube placement.

I usually manually tension the suture and clamp it at the skin using small forceps during the procedure. The supplied guidewire is generally adequate for the whole case (a longer wire would be needed if a primary gastrojejunostomy is contemplated). Once the gastrostomy tube is in position (typically a 12F Wills-Oglesby catheter - in my institution we rarely insert low profile gastrostomies as a primary procedure) I use a Hollister disc to secure it and, having reduced the tension on the anchor suture, tie it to the plastic superstructure of the Hollister disc. This has the advantage of making the suture conspicuous and accessible while obviating the need for suturing into the skin. The suture may be cut at around 10 days post procedure allowing the anchor to fall into the gastric lumen and be eliminated via the GI tract.

Pros and cons

The Cope Gastrointestinal Suture Anchor Set is simple to deploy and for self retaining loop catheter gastrostomies allows the whole procedure to be performed via a single needle puncture.

The supplied guidewire is a useful length for straightforward gastrostomy insertion and permits the procedure to performed using a minimal number of exchanges. I have had one instance of severe post gastrostomy bleeding and have wondered since if the anchor could be safely deployed using a diamond tip needle rather than the 17g cutting needle supplied. This would certainly be more awkward  - once the stomach has been punctured the trocar would have to be removed before the suture could be loaded into the needle and deployed and during this interval it is possible for the stomach to decompress, fall away from the anterior abdominal wall and for position to be lost, thus removing any advantage that may have been gained.  The suture is potentially awkward to deal with post operatively but this can be managed effectively as described above.

Summary

A simple effective device for gastropexy during conventional catheter gastrostomy placement. For low profile gastrostomies more robust gastropexy is desirable.

No conflict. 

Dr Dominic Fay

Consultant Interventional Radiologist

Royal United Hospitals

Bath, UK

 

 

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