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Endoscopic ultrasound-guided placement of fiducial markers using a novel "wet-fill technique" without a bone wax seal.

Endoscopic ultrasound (EUS)-guided placement of fiducial markers for imageguided radiation therapy of gastrointestinal malignancies is usually accomplished by backloading a 22-gauge EUS-fine needle aspiration (FNA) needle with a thinner gold fiducial marker and sealing the needle tip with bone wax [1–3]. We describe a novel “wet-fill technique” for loading a fiducial marker into a needle and placing it in a tumor under EUS guidance that avoids the use of bone wax. The new technique has been used in one patient with pancreatic cancer and three patients with esophageal cancer. A 22-gauge EUS needle (BNX system; Beacon Endoscopic, Newton, Massachusetts, USA) is loaded with a 0.35-mm×1-cm gold coil fiducial (Visicoil; IBA Dosimetry, Schwarzenbruck, Germany) in the following manner: (i) the EUS needle tip is submerged in sterile saline (●" Fig.1a); (ii) the stylet is slowly retracted 10cm to fill