Published online Dec 20, 2025. doi: 10.5662/wjm.v15.i4.106591
Revised: April 12, 2025
Accepted: June 10, 2025
Published online: December 20, 2025
Processing time: 156 Days and 0.5 Hours
Neoadjuvant therapy can reduce the size of gastroesophageal tumors to the extent that they are no longer macroscopically visible. This may increase the risk of microscopic-positive resection margins. One potential method to reduce this uncertainty could be the preoperative endoscopic marking of proximal tumor margins with BioXmark®, a novel liquid fiducial marker. This study aimed to report the initial experiences of the first ten patients marked with BioXmark®.
To evaluate the visibility of BioXmark® on ultrasound after preoperative marking of the proximal resection line of an esophageal tumor.
The circumference of the esophagus was endoscopically marked preoperatively with a fiducial marker in four quadrants, 5 cm proximal to the tumor. During the surgery, the surgeon’s proposed proximal resection line was marked. Next, an ultrasound probe was used to identify the previously placed fiducial markers, and its placement was marked. The difference between the surgeon’s proposed resection line and the fiducial marker was measured intraoperatively and subsequently examined with respect to the resection margin and status.
BioXmark® was implanted in ten patients, 5 cm proximal to the tumor. The surgeon’s proposed resection line was positioned 2-6 cm proximally to the surgical marker line. Technical success of injecting the fiducial marker was achieved in all ten patients. In six patients, the marker was successfully identified intraoperatively on ultrasound. No peri- or postoperative adverse events related to BioXmark® implantation were found.
Excellent technical success with the implantation of the fiducial surgical marker was achieved, but limited intraoperative visibility on ultrasound was achieved. Further studies are required to optimize its clinical application.
Core Tip: This study explores the use of the liquid fiducial marker BioXmark® to enhance precision in cancer surgery. BioXmark® was injected 5 cm proximal to the tumor duringpreoperative nasal gastroscopy. The injected BioXmark® was subsequently identified in vivo using perioperative ultrasound. By improving intraoperative visualization of tumor margins, fiducial markers may increase resection precision and the likelihood of achieving an R0 resection, potentially reducing patient morbidity and mortality. The marker's technical feasibility and safety were demonstrated, although further studies are required to optimize its visibility and clinical application.