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

Gastrointest Endosc. 2010 Jun;71(7):1204-10. doi: 10.1016/j.gie.2010.01.003.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Endosonography / methods*
  • Equipment Design
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Gastrointestinal Neoplasms / diagnostic imaging
  • Gastrointestinal Neoplasms / radiotherapy*
  • Humans
  • Male
  • Middle Aged
  • Needles
  • Reproducibility of Results
  • Retrospective Studies
  • Video Recording*