Endoscopic ultrasound-guided fiducial placement in pancreatic tumors: safety and technical feasibility.

Background and aims: stereotactic body radiation therapy (SBRT) for pancreatic malignancies requires the placement of fiducials to guide treatment delivery. The aim of this study was to assess the safety and feasibility of endoscopic ultrasound (EUS) guided fiducial placement using a 22-gauge needle, in patients with pancreatic cancer undergoing SBRT. Methods: this single-center retrospective study included 47 patients with biopsy-proven advanced pancreatic cancer who underwent EUS-guided fiducial placement between February 2014 and February 2018. Primary outcome measurements included technical success, fiducial migration rate and procedural complications. Results: all 47 patients received a sufficient number of fiducials and could therefore undergo a successful SBRT. The mean number of fiducials inserted per case was 2 +/- 1 (range 1-3) and no fiducial migration was noted. The adverse event rate was 4.2%, as one patient developed mild pancreatitis and another patient required one week of hospitalization one month after fiducial placement due to a duodenal abscess. Conclusions: EUS-guided fiducial placement is a safe and technically feasible procedure in centers with endosonographers that are well trained in EUS with FNA.