Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2020; 12(8): 231-240
Published online Aug 16, 2020. doi: 10.4253/wjge.v12.i8.231
Endoscopic ultrasound-guided fiducial marker placement in pancreatic cancer: A systematic review and meta-analysis
Jaymon B Patel, Vakya Revanur, David G Forcione, Matthew L Bechtold, Srinivas R Puli
Jaymon B Patel, Srinivas R Puli, Department of Gastroenterology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
Vakya Revanur, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
David G Forcione, Department of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, United States
Matthew L Bechtold, Department of Gastroenterology, University of Missouri, Columbia, MO 65203, United States
Author contributions: Patel JB contributed to the data collection, initial draft of manuscript, discussion, revisions; Revanur V contributed to data collection; Forcione DG contributed to critical review of manuscript, drafting revisions; Bechtold ML contributed to critical review of manuscript, drafting revisions; Puli SR contributed to conceptualizing study, data analysis and critical review of manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jaymon B Patel, MD, Assistant Professor, Department of Gastroenterology, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Ave, Peoria, IL 61637, United States. jaymon.b.patel@osfhealthcare.org
Received: April 2, 2020
Peer-review started: April 2, 2020
First decision: April 22, 2020
Revised: May 9, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 16, 2020
Abstract
BACKGROUND

Pancreatic cancer (PC) mortality remains high despite advances in therapy. Combination chemoradiotherapy offers modest survival benefit over monotherapy with either. Fiducial markers serve as needed landmarks for image-guided radiotherapy (IGRT). Traditionally, these markers were placed surgically or percutaneously with limitations of each. Endoscopic ultrasound-guided placement overcomes these limitations.

AIM

To evaluate the safety, efficacy, and feasibility of endoscopic ultrasound (EUS)-guided fiducial placement for PC undergoing IGRT.

METHODS

Articles were searched in MEDLINE, PubMed, and Ovid journals. Pooling was conducted by fixed and random effects models. Heterogeneity was assessed using Cochran’s Q test based upon inverse variance weights.

RESULTS

Initial search identified 1024 reference articles for EUS-guided fiducial placement in PC. Of these, 261 relevant articles were reviewed. Data was extracted from 11 studies (n = 820) meeting inclusion criteria. Pooled proportion of successful placement was 96.27% (95%CI: 95.35-97.81) with fiducial migration rates low at 4.33% (95%CI: 2.45-6.71). Adverse event rates remained low, with overall pooled proportion of 4.85% (95%CI: 3.04-7.03).

CONCLUSION

EUS-guided placement of fiducial markers for IGRT of PC is safe, feasible, and efficacious. The ability to target deep structures under direct visualization while remaining minimally invasive are added benefits. Moreover, the ability to perform fine needle aspiration or celiac plexus neurolysis add value and increase patient-care efficiency. Whether EUS-guided fiducial placement improves outcomes in IGRT or offers any mortality benefits over traditional placement remains unknown and future studies are needed.

Keywords: Endoscopic ultrasound, Pancreatic cancer, Fiducial marker, Image-guided radiotherapy, Systematic review, Meta-analysis

Core tip: Historically, fiducial marker placement for pancreatic cancer has been performed surgically or percutaneously. The former is invasive and the latter is limited to superficial structures and lesions. Endoscopic ultrasound-guided fiducial placement for pancreatic cancer is a safe, efficacious, and feasible modality. It offers a minimally invasive approach that can target deep structures and lesions, and results in more efficient care delivery via the ability to perform additional procedures at the time of marker placement.