Abstract
Background: Endosonography (EUS) has become the standard for loco-regional staging of malignant gastrointestinal tumors. Identification of the tumor's margins with a long-lasting fluoroscopically visible marker will facilitate subsequent surgical and radiation therapy. Tantalum, a biologically inert metal, has been used as radio-opaque material in various areas of medicine. Aims: To assess feasibility of EUS-guided submucosal implantation of a radio-opaque marker in a porcine model. Methods: The study was approved by the Animal Institutional Review Board. Survival experiments were performed on four 50-kg pigs under general anesthesia. A linear array echoendoscope (Olympus® GF-UCT140) was introduced into the esophagus and advanced to the stomach. Using a 19g fine needle aspiration (FNA) needle (EchoTip®; Wilson-Cook Medical Inc., Winston-Salem, NC), a submucosal bleb was created by injecting 3 ml of normal saline into the gastric and esophageal wall followed by 1 ml of tantalum suspension (2.5 gm of tantalum powder (MV Laboratories, NJ) in 10 ml of normal saline) under fluoroscopic observation. Fluoroscopy was repeated after 1, 2 and 4 weeks followed by euthanasia and necropsy. Results: Submucosal injections of saline and tantalum into the gastric and esophageal wall were easily performed through the 19g FNA needle resulting in good fluoroscopic opacification of injected tantalum. Follow up fluoroscopy in 1, 2 and 4 weeks demonstrated stable deposition of the tantalum at the sites of injection. There were no complications during and after the tantalum implantation. Necropsy did not reveal any local or systemic complications. Histological examination of the injection sites revealed submucosal tantalum deposition without signs of infection, inflammation, tissue damage or necrosis. Conclusions: EUS-guided implantation of tantalum as a radio-opaque marker into the submucosal layer of the gastrointestinal tract is technically feasible and safe. Submucosal implantation of tantalum results in long-lasting fluoroscopically visible markings which will facilitate subsequent surgical and radiation therapy.
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