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Endoscopy 2013; 45(11): 933
DOI: 10.1055/s-0033-1344404
Letters to the editor
© Georg Thieme Verlag KG Stuttgart · New York

Hemostatic clips and magnetic resonance imaging. Are there any compatibility issues?

Georgios Mavrogenis
,
Milena Del Natale
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Publication Date:
28 October 2013 (online)

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We read with interest the article by Olmez et al. [1] regarding the case of an Olympus endoclip (Olympus Medical Systems Corp., Tokyo, Japan) that had been retained for more than 2 years. According to the authors, endoclips may be retained for longer than expected, and they propose that a plain abdominal radiograph should be obtained before magnetic resonance imaging (MRI) because the stainless-steel hemostatic clips are contraindications to MRI for safety reasons.

Indeed, it seems that clips may be retained for longer than initially estimated. We recently had experience of a patient who had an Olympus endoclip attached in his stomach for 1 year and 8 months. Should he have avoided an MRI of his spine due to the presence of that clip? To the best of our knowledge no complications have been described in patients with hemostatic clips who underwent MRI. In the era of interventional endoscopy where clips are used widely, not only for the management of gastrointestinal bleeding but also for the sealing of polypectomy and mucosectomy sites, it is difficult to imagine that all of these patients should be warned not to undergo MRI imaging or that an abdominal radiograph should be performed first to exclude the presence of clips.

The question of compatibility of four commercially available hemostatic clips with MRI was addressed by Gill et al. in 2009 [2]. In this study, four different hemostatic clips were deployed in an excised pig stomach (Ethicon Endo-Surgery clip [Ethicon Endo-Surgery, Cincinnati, Ohio, USA]; Resolution clip [Boston Scientific, Natick, Massachusetts, USA]; QuickClip [Olympus Medical Systems]; and the Triclip [Cook Medical, Bloomington, Indiana, USA]). Among the four clips, only the Triclip was considered to be incompatible with MRI as it was the only one that detached under the magnetic field strength of 1.5 T.

In conclusion, we believe that there is no reason to propose a radiograph prior to MRI imaging in patients with hemostatics clips, with the possible exception of patients who have previously received Triclips.