A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery
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作者:
Chang, Patrick W.
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Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Chang, Patrick W.
[1
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Sadik, Jonathan
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Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Sadik, Jonathan
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Sahakian, Ara B.
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Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Sahakian, Ara B.
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Kankotia, Ravi
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Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Kankotia, Ravi
[1
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Ko, Christopher
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Serna, Jessica
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Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Serna, Jessica
[1
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Rodriguez, Alex
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Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Rodriguez, Alex
[1
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Lee, Helen
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Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Lee, Helen
[1
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Kulkarni, Sujit
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Univ Southern Calif, Keck Sch Med, Dept Surg, Div Hepatobiliary Pancreas & Abdominal Transplant, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Kulkarni, Sujit
[2
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Genyk, Yuri
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Univ Southern Calif, Keck Sch Med, Dept Surg, Div Hepatobiliary Pancreas & Abdominal Transplant, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Genyk, Yuri
[2
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Sheikh, Mohd
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Univ Southern Calif, Keck Sch Med, Dept Surg, Div Hepatobiliary Pancreas & Abdominal Transplant, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Sheikh, Mohd
[2
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Buxbaum, James L.
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Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USAUniv Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
Buxbaum, James L.
[1
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机构:
[1] Univ Southern Calif, Keck Sch Med, Dept Internal Med, Div Gastroenterol, Los Angeles, CA 90033 USA
[2] Univ Southern Calif, Keck Sch Med, Dept Surg, Div Hepatobiliary Pancreas & Abdominal Transplant, Los Angeles, CA 90033 USA
Objective: Endoscopic ultrasound (EUS) is routinely used for fiducial marker placement (FMP) to guide stereotactic radiation of pancreatic tumors, but EUS-FMP explicitly to guide surgery has not been studied in a prospective, controlled manner. Multipurpose EUS systems have been developed that facilitate simultaneous EUS-FMP at the time of biopsy. We aimed to evaluate the feasibility of EUS-FMP to guide pancreatic resection. Methods: In this prospective trial, we enrolled patients with resectable pancreas masses undergoing tissue sampling and placed preloaded fiducials immediately after biopsy. Intraprocedure confirmation of carcinoma, neuroendocrine, and nonlymphomatous neoplasia by rapid on-site evaluation and lesion size <4 cm was required. The main outcomes were the feasibility and ease of preoperative placement and intraoperative detection of the markers using predefined Likert scales. Results: In 20 patients, EUS-FMP was successful before planned surgery and placement was technically straightforward (Likert Scale: 9.1 +/- 1.3; range: 1, most challenging to 10, most facile). Intraoperative detection was feasible and improved when compared with a pre-established comparator of 5 representing an equivalent lesion without a marker (Likert Scale: 7.8 +/- 2.2; range: 1, most difficult to 10, most facile; P = 0.011). The mean tumor size on EUS was 1.7 +/- 0.9 (range: 0.5 to 3.6) cm. Conclusion: EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. Preloaded fiducials may be considered for placement at the time of initial referral for EUS-fine needle biopsy.
机构:
Univ Tehran Med Sci, Digest Dis Res Inst, Gene Therapy Res Ctr, Tehran, IranUniv Tehran Med Sci, Digest Dis Res Inst, Gene Therapy Res Ctr, Tehran, Iran
Jamali, Marzieh
Mohamadnejad, Mehdi
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Univ Tehran Med Sci, Digest Dis Res Inst, Liver & Pancreaticobiliary Res Ctr, Tehran, Iran
Shariati Hosp, Digest Dis Res Inst, North Kargar Ave, Tehran 1411713135, IranUniv Tehran Med Sci, Digest Dis Res Inst, Gene Therapy Res Ctr, Tehran, Iran
机构:
Department of Gastroenterology and Hepatology, Changi General Hospital
SingHealth Duke-NUS Academic Medical Centre, Duke-NUS Medical School, Yong Loo Lin School of Medicine, National University of Singapore,Department of Gastroenterology and Hepatology, Changi General Hospital