PMID- 32010751
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 8
IP  - 2
DP  - 2020 Feb
TI  - EUS-guided fiducial placement for pancreatobiliary malignancies: safety, 
      infection risk, and use of peri-procedural antibiotics.
PG  - E179-E185
LID - 10.1055/a-1068-9128 [doi]
AB  - 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.
FAU - Chandnani, Madhuri
AU  - Chandnani M
AD  - Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel 
      Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, 
      United States.
FAU - Faisal, Mir Fahad
AU  - Faisal MF
AD  - Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel 
      Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, 
      United States.
FAU - Glissen-Brown, Jeremy
AU  - Glissen-Brown J
AD  - Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel 
      Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, 
      United States.
FAU - Sawhney, Mandeep
AU  - Sawhney M
AD  - Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel 
      Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, 
      United States.
FAU - Pleskow, Douglas
AU  - Pleskow D
AD  - Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel 
      Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, 
      United States.
FAU - Cohen, Jonah
AU  - Cohen J
AD  - Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel 
      Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, 
      United States.
FAU - Berzin, Tyler M
AU  - Berzin TM
AD  - Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel 
      Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, 
      United States.
LA  - eng
PT  - Journal Article
DEP - 20200122
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC6976327
COIS- Competing interests Dr. Berzin and Dr. Pleskow have received consulting and 
      speaking fees from Medtronic and Boston Scientific.
EDAT- 2020/02/06 06:00
MHDA- 2020/02/06 06:01
PMCR- 2020/02/01
CRDT- 2020/02/04 06:00
PHST- 2019/08/09 00:00 [received]
PHST- 2019/10/07 00:00 [accepted]
PHST- 2020/02/04 06:00 [entrez]
PHST- 2020/02/06 06:00 [pubmed]
PHST- 2020/02/06 06:01 [medline]
PHST- 2020/02/01 00:00 [pmc-release]
AID - 10.1055/a-1068-9128 [doi]
PST - ppublish
SO  - Endosc Int Open. 2020 Feb;8(2):E179-E185. doi: 10.1055/a-1068-9128. Epub 2020 Jan 
      22.