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Pleskow, Douglas

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Pleskow

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Douglas

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Pleskow, Douglas
Author's Publications: search.filters.isAuthorOfPublication.2d329a4a-9ee8-41bf-bb6b-fbb19796a73f

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    Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy
    (2017) Zhang, Lei; Pleskow, Douglas; Turzhitsky, Vladimir; Yee, Eric U.; Berzin, Tyler; Sawhney, Mandeep; Shinagare, Shweta; Vitkin, Edward; Zakharov, Yuri; Khan, Umar; Wang, Fen; Goldsmith, Jeffrey; Goldberg, Saveli; Chuttani, Ram; Itzkan, Irving; Qiu, Le; Perelman, Lev
    Pancreatic cancers are usually detected at an advanced stage and have poor prognosis. About one fifth of these arise from pancreatic cystic lesions. Yet not all lesions are precancerous, and imaging tools lack adequate accuracy for distinguishing precancerous from benign cysts. Therefore, decisions on surgical resection usually rely on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Unfortunately, cyst fluid often contains few cells, and fluid chemical analysis lacks accuracy, resulting in dire consequences, including unnecessary pancreatic surgery for benign cysts and the development of cancer. Here, we report an optical spectroscopic technique, based on a spatial gating fibre-optic probe, that predicts the malignant potential of pancreatic cystic lesions during routine diagnostic EUS-FNA procedures. In a double-blind prospective study in 25 patients, with 14 cysts measured in vivo and 13 postoperatively, the technique achieved an overall accuracy of 95%, with a 95%confidence interval of 78–99%, in cysts with definitive diagnosis.
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    A meta-analysis on efficacy and safety: single-balloon vs. double-balloon enteroscopy
    (Oxford University Press, 2015) Wadhwa, Vaibhav; Sethi, Saurabh; Tewani, Sumeet; Garg, Sushil Kumar; Pleskow, Douglas; Chuttani, Ram; Berzin, Tyler; Sethi, Nidhi; Sawhney, Mandeep
    Background and aim: Double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) are new techniques capable of providing deep enteroscopy. Results of individual studies comparing these techniques have not been able to identify a superior strategy. Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases were searched, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The main outcome measures were complete small-bowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.2). Meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the χ2 and I2 test to assess heterogeneity between trials. Results were expressed as risk ratios (RR) or mean differences with 95% confidence intervals (CI). Results: Four prospective, randomized, controlled trials with a total of 375 patients were identified. DBE was superior to SBE for visualization of the entire small bowel [pooled RR = 0.37 (95% CI: 0.19–0.73; P = 0.004)]. DBE and SBE were similar in ability to provide diagnosis [pooled RR = 0.95 (95% CI: 0.77–1.17; P = 0.62)]. There was no significant difference between DBE and SBE in therapeutic yield [pooled RR = 0.78 (95% CI: 0.59–1.04; P = 0.09)] and complication rate [pooled RR = 1.08 (95% CI: 0.28–4.22); P = 0.91]. Conclusions: DBE was superior to SBE with regard to complete small bowel visualization. DBE was similar to SBE with regard to diagnostic yield, ability to provide treatment and complication rate, but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low to moderate, due to the small sample size.