Chandnani Madhuri, Faisal Mir Fahad, Glissen-Brown Jeremy, Sawhney Mandeep, Pleskow Douglas, Cohen Jonah, Berzin Tyler M
Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States.
Endosc Int Open. 2020 Feb;8(2):E179-E185. doi: 10.1055/a-1068-9128. Epub 2020 Jan 22.
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. 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. 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. 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.
立体定向体部放射治疗（SBRT）联合化疗放疗越来越多地用于局部晚期胰腺胆管癌的优化治疗。在SBRT过程中，使用基准标记物来追踪这些肿瘤。内镜超声（EUS）是放置基准标记物的首选途径，因为它易于接近胰腺胆管结构且放置准确。在此，我们评估了EUS引导下胰腺胆管恶性肿瘤基准标记物放置及围手术期预防性使用抗生素的安全性和感染风险。 这是一项回顾性单中心研究，纳入了2010年7月至2018年2月在一家三级医疗中心由三位专家介入内镜医师为接受SBRT的患者在胰腺胆管区域进行EUS引导下基准标记物放置的连续病例。报告了患者的人口统计学特征、肿瘤特征、EUS技术、基准标记物、预防性抗生素的使用、不良事件（AE）以及SBRT/射波刀治疗情况。 共有355例胰腺胆管恶性肿瘤患者接受了EUS引导下基准标记物放置，其中308例患者（86.76%）成功接受了SBRT。在这些患者中，304例（85.63%）接受了围手术期预防性抗生素治疗。在355例患者中，5.9%（n = 21）出现了AE（轻度至重度），使用或未使用围手术期预防性抗生素的感染发生率无显著差异。只有3例患者出现感染性AE，均与基准标记物放置无明确关联。 EUS引导下胰腺胆管恶性肿瘤基准标记物放置安全有效，感染风险罕见，无论是否使用围手术期抗生素。我们倾向于限制对接受EUS引导下胰腺胆管恶性肿瘤基准标记物放置的患者常规使用围手术期抗生素。
