COMPARATIVE STUDY
JOURNAL ARTICLE
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EUS-guided fiducial placement for image-guided radiation therapy in GI malignancies by using a 22-gauge needle (with videos).

BACKGROUND: Image-guided radiation therapy (IGRT) is dependent on the presence of fiducial markers for target localization and tracking. EUS-guided placement of fiducial markers with a 19-gauge needle has been reported. However, the size and stiffness of the 19-gauge needle may compromise the safety and ease of fiducial placement.

OBJECTIVE: The aim of this study was to evaluate the safety and feasibility of EUS-guided placement of thin flexible gold coil fiducials by using a 22-gauge needle.

DESIGN: Retrospective study.

SETTING: Memorial Sloan-Kettering Cancer Center, between December 2008 and November 2009.

PATIENTS: A total of 30 patients with GI malignancies of the mediastinum and upper abdomen who were to undergo IGRT.

INTERVENTIONS: EUS evaluation with a curvilinear-array echoendoscope was performed. The target lesion was identified, a 22-gauge needle preloaded with a gold coil fiducial was inserted into the lesion, and the fiducial was deployed under EUS guidance.

MAIN OUTCOME MEASUREMENTS: Technical success was defined as the ability to place fiducials in the desired location. Immediate and delayed complications were also noted.

RESULTS: A total of 69 fiducials were placed in 12 different sites in the mediastinum and upper abdomen. Technical success was achieved in 29 out of 30 cases (97%). No intraprocedural complications were encountered. One patient developed a fever and abnormal liver function tests 12 hours after fiducial placement.

LIMITATIONS: Retrospective design, small case series.

CONCLUSIONS: EUS-guided placement of thin flexible gold coil fiducials by using a 22-gauge needle is both safe and feasible for upper GI malignancies.

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