EUS-guided fiducial placement for pancreatobiliary malignancies: safety, infection risk, and use of peri-procedural antibiotics

Madhuri Chandnani; Mir Fahad Faisal; Jeremy Glissen-Brown; Mandeep Sawhney; Douglas Pleskow; Jonah Cohen; Tyler M. Berzin

doi:10.1055/a-1068-9128

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(02): E179-E185
DOI: 10.1055/a-1068-9128

Original article

EUS-guided fiducial placement for pancreatobiliary malignancies: safety, infection risk, and use of peri-procedural antibiotics

Madhuri Chandnani

Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States

,

Mir Fahad Faisal

Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States

,

Jeremy Glissen-Brown

Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States

,

Mandeep Sawhney

Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States

,

Douglas Pleskow

Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States

,

Jonah Cohen

Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States

,

Tyler M. Berzin

Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States

› Institutsangaben

Abstract

Background and study aims Chemoradiation with stereotactic body radiation therapy (SBRT) is increasingly being used for optimal treatment of locally advanced pancreatobiliary cancers. Fiducial markers are used to track these tumors during SBRT. Endoscopic ultrasound (EUS) is the preferred route for fiducial marker placement for ease of access to pancreatobiliary structures and accurate placement. Here we evaluate the safety and infection risk associated with EUS-guided fiducial placement for pancreatobiliary malignancies and use of peri-procedural prophylactic antibiotics.

Patients and methods This was a retrospective, single-center study including consecutive patients presenting for EUS-guided fiducial placement in pancreatobiliary region by three expert interventional endoscopists for SBRT from July 2010 to February 2018 at a tertiary care center. Patient demographics, tumor characteristics, EUS technique, fiducials, use of prophylactic antibiotics, adverse events (AEs) and SBRT/Cyberknife administration were reported.

Results A total of 355 patients with pancreatobiliary malignancy underwent EUS-guided fiducial placement, of whom 308 patients (86.76 %) successfully underwent SBRT. Of the patients, 304 (85.63 %) received peri-procedural prophylactic antibiotic. Of 355 total patients, 5.9 % (n = 21) were noted to develop AEs (mild to severe) with no significant difference in incidence of infection with or without use of peri-procedural prophylactic antibiotic. Only three patients developed infectious AEs, none of which were definitively related to fiducial placement.

Conclusion EUS-guided fiducial placement for pancreatobiliary malignancy is safe and efficacious, and risk of infection is rare, regardless of whether or not peri-procedural antibiotics are used. We favor limiting routine use of peri-procedural antibiotics for patients undergoing EUS-guided fiducial placement in pancreaticobiliary malignancy.

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Referenzen

References
1 Cancer Facts and Figures 2019. Atlanta, Ga: 2019 Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf [Accessed 2019 Jun 9]
2 Cancer Facts and Figures 2018. Atlanta, Ga: 2018 Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf [Accessed 2019 Jun 9]
3 Willett CG, Czito BG, Bendell JC. et al. Locally advanced pancreatic cancer. J Clin Oncol 2005; 23: 4538-4544
4 Choi Y, Kim T-Y, Oh D-Y. et al. Comparison of concurrent chemoradiotherapy and chemotherapy alone for locally advanced pancreatic cancer. J Clin Oncol 2014; 32: 351-351
5 Chang DT, Schellenberg D, Shen J. et al. Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 2009; 115: 665-672
6 Comito T, Cozzi L, Clerici E. et al. Can stereotactic body radiation therapy be a viable and efficient therapeutic option for unresectable locally advanced pancreatic adenocarcinoma? results of a phase 2 study. Technol Cancer Res Treat 2017; 16: 295-301
7 van der Horst A, Lens E, Wognum S. et al. Limited role for biliary stent as surrogate fiducial marker in pancreatic cancer: stent and intratumoral fiducials compared. Int J Radiat Oncol Biol Phys 2014; 89: 641-648
8 Shirato H, Harada T, Harabayashi T. et al. Feasibility of insertion/implantation of 2.0-mm-diameter gold internal fiducial markers for precise setup and real-time tumor tracking in radiotherapy. Int J Radiat Oncol Biol Phys 2003; 56: 240-247
9 Kothary N, Heit JJ, Louie JD. et al. Safety and efficacy of percutaneous fiducial marker implantation for image-guided radiation therapy. J Vasc Interv Radiol 2009; 20: 235-239
10 Kim JH, Hong SS, Kim JH. et al. Safety and Efficacy of Ultrasound-Guided Fiducial Marker Implantation for CyberKnife Radiation Therapy. Korean J Radiol 2012; 13: 30-313
11 Chavalitdhamrong D, DiMaio CJ, Siersema PD. et al. Technical advances in endoscopic ultrasound-guided fiducial placement for the treatment of pancreatic cancer. Endosc Int Open 2015; 3: E373-E377
12 Sanders MK, Moser AJ, Khalid A. et al. EUS-guided fiducial placement for stereotactic body radiotherapy in locally advanced and recurrent pancreatic cancer. Gastrointest Endosc 2010; 71: 1178-1184
13 Majumder S, Berzin TM, Mahadevan A. et al. Endoscopic ultrasound–guided pancreatic fiducial placement. Pancreas 2013; 42: 692-695
14 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
15 Varadarajulu S. Antibiotic prophylaxis is recommended for endoscopic ultrasound-guided fiducial placements. J Clin Gastroenterol 2011; 45: 179
16 Pishvaian AC, Collins B, Gagnon G. et al. EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc 2006; 64: 412-417
17 DiMaio CJ, Nagula S, Goodman KA. et al. EUS-guided fiducial placement for image-guided radiation therapy in GI malignancies by using a 22-gauge needle (with videos). Gastrointest Endosc 2010; 71: 1204-1210
18 Dhadham G, Hoffe S, Harris C. et al. Endoscopic ultrasound-guided fiducial marker placement for image-guided radiation therapy without fluoroscopy: safety and technical feasibility. Endosc Int Open 2016; 4: E378-E382
19 Varadarajulu S, Trevino J, Shen S. et al. The use of endoscopic ultrasound-guided gold markers in image-guided radiation therapy of pancreatic cancers: a case series. Endoscopy 2010; 42: 423-425
20 Park WG, Yan BM, Schellenberg D. et al. EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy. Gastrointest Endosc 2010; 71: 513-518
21 Ammar T, Coté GA, Creach KM. et al. Fiducial placement for stereotactic radiation by using EUS: feasibility when using a marker compatible with a standard 22-gauge needle. Gastrointest Endosc 2010; 71: 630-633
22 Khashab MA, Kim KJ, Tryggestad EJ. et al. Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy. Gastrointest Endosc 2012; 76: 962-971
23 Choi J-H, Seo D-W, Park DH. 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: 88-93
24 Machicado JD, Obuch JC, Goodman KA. et al. Endoscopic ultrasound placement of preloaded fiducial markers shortens procedure time compared to back-loaded markers. Clin Gastroenterol Hepatol 2019; 17: 2749-2758.e2
25 Khashab MA, Chithadi KV, Acosta RD. et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2015; 81: 81-89