ENDOSCOPY: Edited by Anthony N. KallooRole of endoscopic ultrasonography guided fiducial marker placement in gastrointestinal cancerKerdsirichairat, Tossapola; Shin, Eun JibAuthor Information aDivision of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania bDivision of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA Correspondence to Eun Ji Shin, MD, PhD, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower, suite 7125H, Baltimore, MD 21287, USA. Tel: +1 410 614 0950; e-mail: firstname.lastname@example.org Current Opinion in Gastroenterology: September 2020 - Volume 36 - Issue 5 - p 402-408 doi: 10.1097/MOG.0000000000000662 Buy Metrics Abstract Purpose of review Dose escalation radiation therapy such as those delivered by stereotactic body radiation therapy (SBRT) has shown to improve local disease control in multiple types of malignancies. This requires fiducial placement to improve accuracy of treatment and avoid adverse events to adjacent radiosensitive organs during respiration phases. The purpose of this review is to provide updates of recent high-quality articles related to endoscopic ultrasonography (EUS)-guided fiducial placement for gastrointestinal malignancies, particularly in pancreatic cancer, which is expected to be the second leading cause of cancer-related deaths in the USA within this decade. Recent findings A recent systematic review and meta-analysis has shown that EUS-guided fiducial placement for gastrointestinal malignancies has excellent technical success and safety profile. Comparative studies of most commercially available fiducial types via a 22-gauge needle system showed that a 0.035 mm diameter and 10 mm long gold fiducial with coiled configuration, hollow core and external helical design might be favoured due to its most balanced performance of visibility, artifact and migration. Summary A fine balance of performance characteristics of fiducials should be discussed with radiation oncologists to select a suitable and preferred type of fiducials. The comparative studies of other newly developed platinum fiducials and liquid fiducial are pending. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.