Mo1496 Endoscopic Ultrasound Guided (EUS) Fiducial Marker Placement Without Fluoroscopy - Safety and Technical Feasibility

were measured one day after gemcitabine injection and the patients were followed up clinically to assess toxicity. Spiral CT scan was performed at baseline and one month after the second intratumoral injection. After the first intratumoral injection, the patients underwent chemotherapy or chemoradiotherapy at the discretion of oncologist. The primary end point was safety. As the secondary end point the survival rates of the patients were compared with the survival of a matched cohort of 33 patients with locally advanced, unresectable non-metastatic pancreatic cancer patients who were diagnosed with EUS-guided FNA by the same endosonographer over the past 2.5 years and were followed up regularly. Results: Twelve patients with pancreatic cancer (median age: 65.5; range: 44-82 years; 6 males) received intratumoral FNI of gemcitabine. A mean 3.1 of needle passes (range: 2-5) were made to inject mean total volume of 4.2 ml (range: 2-5 ml) at the first session corresponding to a mean 168 mg (range: 80 to 200 mg) of gemcitabine. There was no adverse effect observed with intratumoral gemcitabine therapy. The survival rate at six month was 92% in intartumoral gemcitabine therapy group, as compared with 48% in the control group (P: 0.01). There was no statistically significant difference in one year survival rate between the two groups (42% vs. 21% respectively; P: 0.3). There was a trend for higher median overall survival in the intratumoral gemcitabine group (274 vs. 177 days; P: 0.1 on log rank analysis). None of the patients developed downstaging of the tumor. Conclusions: EUS-guided intratumoral gemcitabine injection is safe in pancreatic cancer. The observed higher rate of 6-month survival with two sessions of intratumoral therapy suggests the short term benefit of this procedure. Further randomized controlled trials are needed to assess the efficacy of repeated intratumoral therapies at 3 months interval. Kaplan-Meier curve for survival in intratumoral gemcitabine group compared to control group Mo1496 Endoscopic Ultrasound Guided (EUS) Fiducial Marker Placement Without Fluoroscopy Safety and Technical Feasibility Gautamy Chitiki Dhadham*, Sarah Hoffe, Jason B. Klapman Advanced Endoscopy, Moffitt Cancer Center, Tampa, FL; Radiation Oncology, Moffitt Cancer Center, Tampa, FL Background: EUS-guided fiducial marker placement to aid in delivery of imageguided radiation therapy (IGRT) of gastrointestinal malignancies is increasing. Most series describe the procedure being performed with fluoroscopy. The aim of our study is to report the technical feasibility,safety and migration rate of fiducial marker placement in a large cohort of patients with gastrointestinal malignancies who underwent EUS-guided fiducial marker placement prior to simulation for IGRT without fluoroscopy. Methods: A retrospective chart review was performed on all patients referred for EUS-guided fiducial marker placement from 08/1/07 -7/ 31/14 at Moffitt Cancer Center. In total, 514 patients were identified and included in the study. Results: 514 patients underwent placement of 1093 gold fiducial markers under EUS-guidance without fluoroscopy during the study period. Patients underwent simulation within 72 hours of fiducial placement where correct placement /migration was identified on the treatment planning CT. 240 patients with Eso/GEJ cancer had 405 fiducials placed. 223 patients had placement of the 1 cm X 0.75 mm fiducial backloaded into a 19 ga EUS needle and secured with bone wax. The remaining cases were placed using the 22 ga with a 1cm X 0.35 mm www.giejournal.org Vol fiducial marker. 510 fiducials were placed in 188 patients with pancreatic cancer. The majority were placed using either the 22ga (414) or the 19ga needle (93). Technical difficulty (intervening blood vessels) was noted in 16 patients, however fiducials were placed in a narrow window. Minor bleeding, which resolved spontaneously, was noted in 7 patients. Intraprocedural fiducial migration was noted in 2 patients. 54 patients with rectal cancer had 103 fiducials placed. 38 patients had fiducials placed in the muscularis propria both proximal and distal to the lesion, 9 had proximal only, and 7 had distal only. Minor bleeding was noted which resolved spontaneously in 1 patient. Technical difficulty was also noted only in 1. 32 patients had 75 fiducials placed into other GI tract lesions. Technical difficulty was noted in placing fiducials into one liver lesion. 2 fiducials slipped during placement into the gastrohepatic ligament and porta hepatis lymph nodes, and minor bleeding was noted in 1 fiducial placed in a subcarinal lymph node. Regarding fiducial migration, only 2 (.002%) fiducials in 2 esophageal patients migrated which was noted on initial simulation. Conclusions: In the largest retrospective review to date, EUS-guided fiducial marker placement without fluoroscopy is technically feasible and safe. There were minimal intraprocedure/post procedure complications. Imaging at the time of simulation also revealed the migration rate to be extremely low. These results may allow for more widespread adoption of EUS-guided fiducial marker placement in centers where fluoroscopy is not readily available. Mo1497 Endosonographic Examination of the Thyroid Gland Among Patients With Cancers Abdulah A. Mahayni, Ghaleb Chawki*, Leon J. Yoder, Fateh A. Elkhatib, Amer A. Alkhatib Gastroenterology, Cancer Treatment Centers of America, Tulsa, OK; The Cleveland Clinic, Abu Dhabi, United Arab Emirates; Gastroenterology, Oklahoma State University, Tulsa, OK; Endocrinology, Integris Health, Oklahoma city, OK Objectives: There is very limited endosonographic literature regarding the thyroid gland, which is frequently visualized during upper endoscopic ultrasound (EUS). Our objective was to describe the normal endosonographic dimensions of the thyroid gland and the prevalence of benign and malignant thyroid lesions encountered during upper EUS within a cancer center setting. Methods: 100 upper EUS procedures, performed between October 2012 and July 2014, included endosonographic examination of the thyroid gland using a radial ultrasound. Data collected prospectively included patients demography, underlying thyroid conditions, thyroid gland dimensions, the presence or absence of thyroid lesions, interventions performed to characterize thyroid lesions and pathology results when applicable. Results: Most of the thyroid glands were endosonographically visualized when the tip of the scope was at 18 cm from the incisors. The average thyroid gland dimensions were 24.5 x 16.4 mm (range 9.6-38.2mm x 8.4-29mm) and 95% intervals (14.6-34.4mm x 7.7-25.1mm). Ten cases showed thyroid lesions. Interestingly, 3 previously undiagnosed thyroid cancers were discovered during EUS (two primary papillary thyroid cancers and one anaplastic thyroid cancer). Transesophageal endosonographically guided fine needle aspiration of a thyroid lesion was feasible when the lesion was detected in the inferior portions of the thyroid gland and the tip of the scope was at 18 cm or more from the incisors. Conclusions: Routine EUS examination may detect unexpected thyroid lesions including malignant ones. The endosonographer should examine the thyroid gland while keeping in mind the limitations of EUS in obtaining a full examination of the entire thyroid gland. Demographic features of the patients enrolled in this study