EUS-Guided Fiducial Placement

  • Aamir N. Dam
  • Jason B. KlapmanEmail author


Fiducial markers are radiopaque markers implanted inside or adjacent to a tumor to aid in image-guided radiation therapy. Image-guided radiation therapy (IGRT) enables precise targeting of the lesion, minimizes toxicity to adjacent normal structures, and takes into account motion of the tumor during respiration. Traditionally, fiducial markers were placed percutaneously or surgically. More recently, endoscopic ultrasound (EUS)-guided fiducial placement has been reported. Both retrospective and prospective studies have demonstrated that EUS-guided fiducial placement is safe and feasible in various malignancies with low complication rates. There are several fiducial deployment techniques and different commercially available fiducial types that have been described in the literature. Technical success rates have ranged between 85 and 100%, with higher success rates in more recent studies even without the use of fluoroscopy. Data on long-term durability of fiducials during radiation therapy are favorable, although studies evaluating survival benefit are lacking. This chapter will summarize the role of EUS in the placement of fiducial markers to aid IGRT to treat various gastrointestinal and nongastrointestinal malignancies.


Endosonography Fiducial markers Pancreatic cancer Esophageal cancer Rectal cancer Image-guided radiation therapy Gastrointestinal malignancy 

Supplementary material

Video 10.1

EUS deployment of fiducials using the back-loading technique (MP4 137992 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Gastrointestinal OncologyMoffitt Cancer CenterTampaUSA

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