Fiducial placement for stereotactic radiation by using EUS: feasibility when using a marker compatible with a standard 22-gauge needle

• Published in: Gastrointestinal endoscopy Vol. 71; no. 3; pp. 630 - 633
• Main Authors: Ammar, Tarek, MD, Coté, Gregory A., MD, MS, Creach, Kimberly M., MD, Kohlmeier, Cara, RDMS, Parikh, Parag J., MD, Azar, Riad R., MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01-03-2010; Elsevier
• Subjects: Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Endosonography - instrumentation; Endosonography - methods; Equipment Design; Feasibility Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Neoplasms - radiotherapy; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Needles; Peritoneal Neoplasms - secondary; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; IGRT; image-guided radiation therapy; Sonography; Endoscopic route; Endoscopic ultrasonography; Needle; Echography; Stereotaxia; Feasibility
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2009.11.023

Background Stereotactic radiation by using fiducial markers permits higher doses of radiation while reducing the exposure of uninvolved, adjacent structures. EUS has been used to deploy fiducials, although a 19-gauge needle has traditionally been required. Objective To report a new technique and the feasibility of deploying a fiducial compatible with a 22-gauge needle under EUS guidance. Design Single-center, case series. Setting Tertiary care referral center. Patients Thirteen patients with primary or metastatic cancer referred for stereotactic radiation. Interventions EUS-guided placement of a single fiducial marker that is compatible with a 22-gauge EUS-FNA needle. Main Outcome Measurements Technical success and complications. Results Thirteen patients referred for EUS-guided placement of a fiducial marker were identified in the endoscopic database. Targeted lesions measured 27 ± 13 mm (range 8-50) × 21 ± 10 mm (range 6-42). All fiducials were successfully deployed, 9 using a transgastric and 4 using a transduodenal approach. There were no EUS-associated complications. Two patients did not proceed to radiation therapy as a result of interval peritoneal metastasis. However, all fiducials were visible on the roentogram. Eleven of 13 patients (85%) required placement of 1 fiducial, whereas 2 patients (15%) required 2 fiducials. Limitations Uncontrolled feasibility study with limited sample size and follow-up. Conclusion EUS-guided placement of a fiducial using a 22-gauge needle is technically feasible and may permit greater access compared with the 19-gauge needle technique.