Volume 4, Issue 5, Pages 223-225 (May 2019) Novel EUS-guided brachytherapy treatment of pancreatic cancer with phosphorus-32 microparticles: first United States experience  Manoop S. Bhutani, MD, FASGE, Irina M. Cazacu, MD, Alexandra A. Luzuriaga Chavez, MD, Ben S. Singh, BA, Franklin C.L. Wong, MD, William D. Erwin, MS, Eric P. Tamm, MD, Geena G. Mathew, MS, Dao B. Le, PharmD, Eugene J. Koay, MD, PhD, Cullen M. Taniguchi, MD, PhD, Bruce D. Minsky, MD, Shubham Pant, MD, Ching-Wei D. Tzeng, MD, Albert C. Koong, MD, PhD, Gauri R. Varadhachary, MD, Matthew H.G. Katz, MD, Robert A. Wolff, MD, David R. Fogelman, MD, Joseph M. Herman, MD  VideoGIE  Volume 4, Issue 5, Pages 223-225 (May 2019) DOI: 10.1016/j.vgie.2019.02.009 Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Overview of phosphorus-32 microparticles P-32 implantation. VideoGIE 2019 4, 223-225DOI: (10.1016/j.vgie.2019.02.009) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 CT view of hypodense tumor, 5.0 × 3.6 cm (white arrows), in the pancreatic body before therapy. It encases the splenic vein and splenic artery, and it partially encases the celiac axis and the portal vein confluence. VideoGIE 2019 4, 223-225DOI: (10.1016/j.vgie.2019.02.009) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 EUS view showing the hypoechoic tumor after injection of phosphorus-32 microparticles P-32 injection mostly replaced by the hyperechoic “cloud” (arrowheads) and the catheter sheath at the edge of the tumor through which P-32 was delivered (arrow). VideoGIE 2019 4, 223-225DOI: (10.1016/j.vgie.2019.02.009) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 Single photon emission computed tomography/CT bremsstrahlung imaging showing excellent intratumoral retention of activity within the pancreatic body 4 hours after implantation. VideoGIE 2019 4, 223-225DOI: (10.1016/j.vgie.2019.02.009) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 Follow-up CT scan showing a decrease in tumor size (white arrows) from 5.0 × 3.6 cm at baseline to 4.2 × 2.8 cm at week 16, with improvement of the caliber of the splenoportal confluence. VideoGIE 2019 4, 223-225DOI: (10.1016/j.vgie.2019.02.009) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions