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Safety and Feasibility of Same-session Endoscopic Ultrasound-guided Biopsy and Fiducial Placement in Pancreatic Cancer

Published:January 17, 2021DOI:https://doi.org/10.1016/j.tige.2021.01.004

      ABSTRACT

      Background

      In patients with pancreas adenocarcinoma (PDAC), performing endoscopic ultrasound (EUS)-guided fiducial placement at the time of initial EUS-guided biopsies may obviate a second procedure, streamline care, and improve resource utilization. However, the safety of this combined approach is understudied.

      Methods

      We retrospectively identified and reviewed cases at a single institution in which patients with PDAC underwent EUS-guided biopsy and same session fiducial placement. Patient and procedural characteristics were abstracted. Intraprocedural and postprocedural adverse events were classified according to the American Society for Gastrointestinal Endoscopy Lexicon for Adverse Events. The percentage of “definite” and “probable” adverse events occurring within 14 days of the procedure was calculated.

      Results

      Thirty-three patients were included in this series (median age 64, 42% male). The median numbers of biopsies performed and fiducials placed were 3 (range 2-7) and 4 (range 1-4), respectively, per patient. A 22-gauge needle was used for the majority of biopsies (81.8%) and all fiducial placements (100%). No definite and one probable adverse event of mild postprocedural pain was noted (3.0%, 1/33). There were no episodes of significant bleeding, pancreatitis or infection. Fiducials were successfully used in the administration of radiation to all patients.

      Conclusion

      We report a low risk of adverse events in the setting of combined EUS-guided biopsy and fiducial placement. In the appropriate setting, this approach may streamline care for patients with PDAC while avoiding time, cost, and risks associated with an additional procedure or impacting radiation therapy. Larger, controlled studies are needed to validate the safety and efficacy of this combined approach.

      Keywords

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      References

        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2020.
        CA Cancer J Clin. 2020; 70: 7-30
        • Wadhwa V.
        • Patwardhan S.
        • Garg S.K.
        • et al.
        Inpatient burden of pancreatic cancer in the United States: an analysis of national trends in the United States from 1997 to 2012.
        Pancreas. 2016; 45 (e41-e2)
        • Palta M.
        • Godfrey D.
        • Goodman K.A.
        • et al.
        Radiation therapy for pancreatic cancer: executive Summary of an ASTRO Clinical Practice Guideline.
        Pract Radiat Oncol. 2019; 9 (Epub 2019/09/03): 322-332
        • Choi J.-.H.
        • Seo D-W
        • Do Hyun Park S.K.L.
        • et al.
        Fiducial placement for stereotactic body radiation therapy under only endoscopic ultrasonography guidance in pancreatic and hepatic malignancy: practical feasibility and safety.
        Gut Liver. 2014; 8: 88
        • Coronel E.
        • Cazacu I.M.
        • Sakuraba A.
        • et al.
        EUS-guided fiducial placement for GI malignancies: a systematic review and meta-analysis.
        Gastrointest Endosc. 2019; 89 (e18Epub 2018/11/18): 659-670
        • Cheesman A.R.
        • DiMaio C.J.
        Role and technique of endoscopic ultrasound placement of fiducial markers in gastrointestinal malignancies.
        Tech Gastrointest Endosc. 2017; 19: 213-218
        • Cotton P.B.
        • Eisen G.M.
        • Aabakken L.
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71 (Epub 2010/03/02): 446-454
        • Murad M.H.
        • Sultan S.
        • Haffar S.
        • et al.
        Methodological quality and synthesis of case series and case reports.
        BMJ Evid Based Med. 2018; 23 (Epub 2018/02/09): 60-63
        • Bazerbachi F.
        • Dobashi A.
        • Kumar S.
        • et al.
        Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion (BRTOcc) of gastrorenal shunts in patients with bleeding gastric fundal varices.
        Gastroenterol Rep. 2020; https://doi.org/10.1093/gastro/goaa082
        • Tian G.
        • Ye Z.
        • Zhao Q.
        • et al.
        Complication incidence of EUS-guided pancreas biopsy: a systematic review and meta-analysis of 11 thousand population from 78 cohort studies.
        Asian J Surg. 2020; 43 (Epub 2020/01/25): 1049-1055
        • Chong C.C.N.
        • Lakhtakia S.
        • Nguyen N.
        • et al.
        Endoscopic ultrasound-guided tissue acquisition with or without macroscopic on-site evaluation: randomized controlled trial.
        Endoscopy. 2020; 52 (Epub 2020/06/05): 856-863
        • Qadan M.
        • Hong T.S.
        • Tanabe K.K.
        • et al.
        A multidisciplinary team approach for triage of elective cancer surgery at the Massachusetts General Hospital during the novel coronavirus COVID-19 outbreak.
        Ann Surg. 2020; 272: e20-e21
      1. November 2, 2018 Federal Register CMS-1695-F and December 28, 2018 Federal Register CMS-1695-CN2.