© 2019 Pan-Arab Association of Gastroenterology A 53-year-old male was diagnosed with invasive adenocarcinoma of the pre-pyloric region. Imaging studies ruled out metastatic disease. The patient underwent neo-adjuvant chemotherapy followed by a partial gastrectomy. CT scan at 18 months’ post-resection demonstrated right upper quadrant lesions suspicious for metastatic disease. EUS exam shows two round hypoechoic lesions. Fine needle aspiration with suction was performed with on-site cytology confirming malignant cells in the masses. Five gold fiducial markers were placed. Final pathology confirmed adenocarcinoma. The patient was subsequently started on stereotactic body radiation therapy (SBRT) with good results. This is the first case report EUS-guided fiducial markers for recurrent gastric cancer post-gastrectomy.