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Pancreatic Neoplasms: HELP
Articles by Douglas K. Pleskow
Based on 13 articles published since 2008
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Between 2008 and 2019, D. Pleskow wrote the following 13 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Changing the way we do business: recommendations to accelerate biomarker development in pancreatic cancer. 2013

Tempero, Margaret A / Klimstra, David / Berlin, Jordan / Hollingsworth, Tony / Kim, Paula / Merchant, Nipun / Moore, Malcolm / Pleskow, Doug / Wang-Gillam, Andrea / Lowy, Andrew M. ·Pancreas Center, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94115, USA. mtempero@medicine.ucsf.edu ·Clin Cancer Res · Pubmed #23344262.

ABSTRACT: Pancreatic ductal adenocarcinoma is the most aggressive of all epithelial malignancies. In contrast to the favorable trends seen in most other common malignancies, the five-year survival of patients with this disease remains only 6%, a statistic that has changed minimally for decades. Only two drugs have been approved by the U.S. Food and Drug Administration (FDA) for use in pancreatic cancer in the last 15 years, and there are no established strategies for early detection.

2 Review Clinical application of intraductal ultrasound during endoscopic retrograde cholangiopancreatography. 2009

Kundu, Rabi / Pleskow, Douglas. ·Division of Gastroenterology, UCSF Fresno, 2823 Fresno Street, 1st Floor Endoscopy Suite, Fresno, CA 93721, USA. ·Gastrointest Endosc Clin N Am · Pubmed #19917467.

ABSTRACT: Intraductal ultrasound (IDUS) used during endoscopic retrograde cholangiopancreatography (ERCP) can facilitate reliable evaluation of biliary and pancreatic disorders. The smaller diameter, flexibility, and the image quality offered by IDUS devices makes them ideal for evaluating a variety of difficult biliary and pancreatic diseases, especially in undefined strictures, luminal filling defects, and ampullary neoplasms. This article examines the numerous possible roles for IDUS in the evaluation of biliary and pancreatic conditions, as well as in ampullary neoplasms. IDUS is a simple, easy to learn, and safe technique that should be considered an integral tool in the therapeutic endoscopist's armamentarium.

3 Article Performance of a fully disposable, digital, single-operator cholangiopancreatoscope. 2017

Shah, Raj J / Raijman, Isaac / Brauer, Brian / Gumustop, Bora / Pleskow, Douglas K. ·Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States. · Gastroenterology, St. Lukes Hospital, Houston, Texas, United States. · Gastroenterology, St. Peter's Hospital, Albany, New York, United States. · Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States. ·Endoscopy · Pubmed #28511237.

ABSTRACT:

4 Article Chronic Pancreatitis-Like Change in BRCA2 Mutation Carriers. 2017

Mizrahi, Meir / Tseng, Jennifer F / Wong, Daniel / Tung, Nadine / Eskander, Mariam F / Berzin, Tyler M / Pleskow, Douglas K / Sawhney, Mandeep S. ·From the Divisions of *Gastroenterology, †Surgical Oncology, and ‡Medical Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. ·Pancreas · Pubmed #28375947.

ABSTRACT: OBJECTIVES: Pancreatic intraepithelial neoplasia lesions can appear as chronic pancreatitis-like changes on endoscopic ultrasound (EUS). The aim of our study was to determine if BRCA2 mutation carriers were more likely than noncarriers to demonstrate chronic pancreatitis-like changes on EUS. METHODS: Patients with BRCA2 mutations referred for EUS were identified (cases) from an endoscopy database. Controls were matched with cases in a 2:1 ratio for sex, date EUS was performed, endoscopist, and echoendoscope. Data were extracted from medical records, EUS reports, and EUS images. Rosemont classification was used to categorize chronic pancreatitis-like changes. RESULTS: During the study period, 37 BRCA2 mutation carriers and 92 controls underwent EUS. Compared with controls, BRCA2 mutation carriers had a higher prevalence of solid pancreas lesions (16.2% vs 1.08%; P = 0.005), pancreatic cysts (21.6% vs 6.1%; P = 0.01), Rosemont "consistent with chronic pancreatitis" definition changes (13.5% vs 1%; P = 0.002), and Rosemont "suggestive of chronic pancreatitis" definition changes (16.2% vs 2.1%; P = 0.003). After adjusting for age, alcohol use, and smoking, BRCA2 mutation carriers were almost 25 times more likely to demonstrate chronic pancreatitis-like changes. CONCLUSIONS: Chronic pancreatitis-like changes, along with solid and cystic pancreatic lesions, were significantly more common in BRCA2 mutation carriers than in noncarriers.

5 Article Double-duct sign in the era of endoscopic ultrasound: the prevalence of occult pancreaticobiliary malignancy. 2014

Cohen, Jonah / Sawhney, Mandeep S / Pleskow, Douglas K / Chuttani, Ram / Patel, Nirav J / Sheridan, Jennifer / Berzin, Tyler M. ·Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. ·Dig Dis Sci · Pubmed #24705640.

ABSTRACT: BACKGROUND AND AIM: Simultaneous dilatation of the common bile duct and pancreatic duct, "double-duct sign" (DDS), is an ominous finding concerning for pancreaticobiliary malignancy. Little evidence exists to guide the initial evaluation and subsequent follow-up for patients with DDS in the absence of jaundice or focal mass noted on computed tomography (CT)/ magnetic resonance imaging (MRI). Endoscopic ultrasound (EUS) is often recommended in the evaluation of such patients, however, the prevalence of malignancy remains unclear. We sought to determine the prevalence of pancreaticobiliary neoplasm in this patient group on initial EUS evaluation and on subsequent clinical follow-up. METHODS: We performed a retrospective analysis of a prospective database at a tertiary-care academic medical center between 2010 and 2012. Eighty-two patients were identified who underwent EUS evaluation for DDS without evidence of a mass on CT/MRI and without jaundice. RESULTS: Sixty-eight of 82 patients had confirmed DDS on EUS with biductal dilation. Six (9 %) of 68 patients were found to have a mass lesion on EUS. In these patients, final diagnoses were pancreatic carcinoma (n = 4), ampullary carcinoma (n = 1) and ampullary adenoma (n = 1). In the 62 patients without evidence of a focal mass on initial EUS, the most common diagnoses were benign ductal dilation (n = 42), chronic pancreatitis (n = 9) and choledocholithiasis (n = 8). Fifty-eight (94 %) of 62 patients had documented median follow-up of 13 months, and none developed subsequent evidence of previously unrecognized malignancy. CONCLUSIONS: The presence of double-duct sign on EUS in patients without jaundice or mass lesion on CT/MRI is most frequently associated with benign conditions. When a mass is not detected on EUS, subsequent evidence of malignancy is unlikely.

6 Article Endoscopic ultrasound-guided pancreatic fiducial placement: how important is ideal fiducial geometry? 2013

Majumder, Shounak / Berzin, Tyler M / Mahadevan, Anand / Pawa, Rishi / Ellsmere, James / Sepe, Paul S / Larosa, Salvatore A / Pleskow, Douglas K / Chuttani, Ram / Sawhney, Mandeep S. ·Department of Medicine, University of Connecticut, Farmington, CT, USA. ·Pancreas · Pubmed #23548880.

ABSTRACT: OBJECTIVE: Image-guided radiation therapy allows precise tumor targeting using real-time tracking of radiopaque fiducial markers. To enable appropriate tracking, it is recommended to place fiducials with "ideal fiducial geometry" (IFG). Our objectives were to determine the proportion of patients in whom IFG can be achieved when fiducials are placed by endoscopic ultrasound (EUS) and surgery and to determine if attaining IFG is necessary for delivering radiation. METHODS: This single-center retrospective cohort study included 77 patients with biopsy-proven advanced pancreatic cancer who underwent either EUS-guided or laparotomy/laparoscopy-assisted fiducial placement between September 2005 and July 2009. RESULTS: Gold fiducials were implanted by EUS in 39 patients (51%) and by surgery in 38 patients (49%). The proportion of patients with IFG was significantly higher for surgical placement [18/38, 47%; 95% confidence interval (CI), 32%-63%] compared with EUS-guided placement (7/39, 18%; 95% CI, 8%-32%), P = 0.0011. However, fiducial tracking was successfully used for Cyberknife therapy in 35 (90%) of 39 (95% CI, 77%-97%) patients in the EUS group compared with 31 (82%) of 38 (95% CI, 67%-92%) patients in the surgery group. There were 5 procedure-related complications in the EUS group. CONCLUSIONS: Achieving IFG appears unnecessary for successful tracking and delivery of radiation.

7 Article Classification of probe-based confocal laser endomicroscopy findings in pancreaticobiliary strictures. 2012

Meining, A / Shah, R J / Slivka, A / Pleskow, D / Chuttani, R / Stevens, P D / Becker, V / Chen, Y K. ·Klinikum rechts der Isar, Munich, Germany. ·Endoscopy · Pubmed #22261749.

ABSTRACT: BACKGROUND AND STUDY AIMS: The accurate diagnosis of indeterminate pancreaticobiliary strictures presents a clinical dilemma. Probe-based confocal laser endomicroscopy (pCLE) offers real-time in vivo microscopic tissue examination that may increase sensitivity for the detection of malignancy. the objective of this study was to develop and validate a standard descriptive classification of pcle in the pancreaticobiliary system. PATIENTS AND METHODS: A total of 102 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with pCLE to assess indeterminate pancreaticobiliary strictures were enrolled in a multicenter registry; 89 of these patients were evaluable. Information and data on the following were collected prospectively: clinical, ERCP, tissue sampling, pCLE, and follow-up. A uniform classification of pCLE findings ("Miami Classification") was developed, consisting of a set of image interpretation criteria. Thereafter, these criteria were tested through blinded consensus review of 112 randomized pCLE videos from 47 patients, and inter-observer variability was assessed in 42 patients . RESULTS: A consensus definition of the specific criteria of biliary and pancreatic pCLE findings for indeterminate strictures was developed. Single-image interpretation criteria did not have a high enough sensitivity for predicting malignancy. However, combining two or more criteria significantly increased the sensitivity and predictive values. The characteristics most suggestive of malignancy included the following: thick white bands (>20 µm), or thick dark bands (>40 µm), or dark clumps or epithelial structures. These provided sensitivity, specificity, positive predictive value, and negative predictive value of 97%, 33%, 80%, and 80% compared with 48%, 100%, 100%, and 41% for standard tissue sampling methods. Inter-observer variability was moderate for most criteria. CONCLUSION: The Miami Classification enables a structured, uniform, and reproducible description of pancreaticobiliary pCLE. Combining individual characteristics improves the sensitivity for the detection of malignancy.

8 Article Direct visualization of indeterminate pancreaticobiliary strictures with probe-based confocal laser endomicroscopy: a multicenter experience. 2011

Meining, Alexander / Chen, Yang K / Pleskow, Douglas / Stevens, Peter / Shah, Raj J / Chuttani, Ram / Michalek, Joel / Slivka, Adam. ·II Medical Klinik, Klinikum rechts der Isar, Munich, Germany. ·Gastrointest Endosc · Pubmed #21802675.

ABSTRACT: BACKGROUND: Because of the low sensitivity of current ERCP-guided tissue sampling methods, management of patients with indeterminate pancreaticobiliary strictures is a challenge. Probe-based confocal laser endomicroscopy (pCLE) enables real-time microscopic visualization of strictures during an ongoing ERCP. OBJECTIVE: To document the utility, performance, and accuracy of real-time pCLE diagnosis compared with histopathology. DESIGN: Prospective observational study within the framework of a multicenter registry. SETTING: Five academic centers. PATIENTS: This study involved 102 patients with indeterminate pancreaticobiliary strictures. INTERVENTION: Clinical information, ERCP findings, tissue sampling results, and pCLE videos were collected prospectively. Investigators were asked to provide a presumptive diagnosis based on pCLE during the procedure before pathology results were available. All patients received at least 30 days of follow-up until definitive diagnosis of malignancy was established or 1-year follow-up if index tissue sampling was benign. MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy, sensitivity, specificity of ERCP-guided pCLE compared with ERCP with tissue acquisition. RESULTS: There were no pCLE-related adverse events in the study. We were able to evaluate 89 patients, of whom 40 were proven to have cancer. The sensitivity, specificity, positive-predictive value, and negative-predictive value of pCLE for detecting cancerous strictures were 98%, 67%, 71%, and 97%, respectively, compared with 45%, 100%, 100%, and 69% for index pathology. This resulted in an overall accuracy of 81% for pCLE compared with 75% for index pathology. Accuracy for combination of ERCP and pCLE was significantly higher compared with ERCP with tissue acquisition (90% vs 73%; P = .001). LIMITATIONS: Investigators had access to all relevant clinical information, which may have biased the predictive characteristics of pCLE. CONCLUSION: Probe-based CLE provides reliable microscopic examination and has excellent sensitivity and negative predictive value. The significantly higher accuracy of ERCP and pCLE compared with ERCP with tissue acquisition may support supplementing ERCP with pCLE.

9 Article Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. 2011

Mahadevan, Anand / Miksad, Rebecca / Goldstein, Michael / Sullivan, Ryan / Bullock, Andrea / Buchbinder, Elizabeth / Pleskow, Douglas / Sawhney, Mandeep / Kent, Tara / Vollmer, Charles / Callery, Mark. ·Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. amahadev@bidmc.harvard.edu ·Int J Radiat Oncol Biol Phys · Pubmed #21658854.

ABSTRACT: PURPOSE: Stereotactic body radiotherapy (SBRT) has been used successfully to treat patients with locally advanced pancreas cancer. However, many patients develop metastatic disease soon after diagnosis and may receive little benefit from such therapy. We therefore retrospectively analyzed a planned strategy of initial chemotherapy with restaging and then treatment for those patients with no evidence of metastatic progression with SBRT. METHODS AND MATERIALS: Forty-seven patients received gemcitabine (1,000 mg/m(2) per week for 3 weeks then 1 week off) until tolerance, at least six cycles, or progression. Patients without metastases after two cycles were treated with SBRT (tolerance-based dose of 24-36 Gy in 3 fractions) between the third and fourth cycles without interrupting the chemotherapy cycles. RESULTS: Eight of the 47 patients (17%) were found to have metastatic disease after two cycles of gemcitabine; the remaining 39 patients received SBRT. The median follow-up for survivors was 21 months (range, 6-36 months). The median overall survival for all patients who received SBRT was 20 months, and the median progression-free survival was 15 months. The local control rate was 85% (33 of 39 patients); and 54% of patients (21 of 39) developed metastases. Late Grade III toxicities such as GI bleeding and obstruction were observed in 9% (3/39) of patients. CONCLUSION: For patients with locally advanced pancreas cancer, this strategy uses local therapy for those who are most likely to benefit from it and spares those patients with early metastatic progression from treatment. SBRT delivers such local therapy safely with minimal interruption to systemic chemotherapy, thereby potentially improving the outcome in these patients.

10 Article Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. 2010

Mahadevan, Anand / Jain, Sanjay / Goldstein, Michael / Miksad, Rebecca / Pleskow, Douglas / Sawhney, Mandeep / Brennan, Darren / Callery, Mark / Vollmer, Charles. ·Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. amahadev@bidmc.harvard.edu ·Int J Radiat Oncol Biol Phys · Pubmed #20171803.

ABSTRACT: PURPOSE: Patients with nonmetastatic locally advanced unresectable pancreatic cancer have a dismal prognosis. Conventional concurrent chemoradiotherapy requires 6 weeks of daily treatment and can be arduous. We explored the safety and effectiveness of a 3-day course of hypofractionated stereotactic body radiotherapy (SBRT) followed by gemcitabine in this population. PATIENTS AND METHODS: A total of 36 patients with nonmetastatic, locally advanced, unresectable pancreatic cancer with ≥12 months of follow-up were included. They received three fractions of 8, 10, or 12 Gy (total dose, 24-36 Gy) of SBRT according to the tumor location in relation to the stomach and duodenum, using fiducial-based respiratory motion tracking on a robotic radiosurgery system. The patients were then offered gemcitabine for 6 months or until tolerance or disease progression. RESULTS: With an overall median follow-up of 24 months (range, 12-33), the local control rate was 78%, the median overall survival time was 14.3 months, the median carbohydrate antigen 19-9-determined progression-free survival time was 7.9 months, and the median computed tomography-determined progression-free survival time was 9.6 months. Of the 36 patients, 28 (78%) eventually developed distant metastases. Six patients (17%) were free of progression at the last follow-up visit (range, 13-30 months) as determined by normalized tumor markers with stable computed tomography findings. Nine Grade 2 (25%) and five Grade 3 (14%) toxicities attributable to SBRT occurred. CONCLUSION: Hypofractionated SBRT can be delivered quickly and effectively in patients with nonmetastatic, locally advanced, unresectable pancreatic cancer with acceptable side effects and minimal interference with gemcitabine chemotherapy.

11 Article Periductal hypoechoic sign: an endosonographic finding associated with pancreatic malignancy. 2010

Lee, Suck-Ho / Ozden, Nuri / Pawa, Rishi / Hwangbo, Young / Pleskow, Douglas K / Chuttani, Ram / Sawhney, Mandeep S. ·Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. ·Gastrointest Endosc · Pubmed #19922915.

ABSTRACT: BACKGROUND: Despite advances in imaging, differentiating benign from malignant causes of pancreatic duct dilation is difficult. OBJECTIVE: The aim of our study was to assess the accuracy of the periductal hypoechoic sign (PHS), defined as patchy hypoechoic areas adjacent to a dilated pancreatic duct, for the diagnosis of pancreatic malignancy. DESIGN: Single-center, retrospective analysis. SETTING: Tertiary care university hospital. PATIENTS: All patients who underwent EUS from 2006 to 2008 for evaluation of pancreatic pathology were identified. Those with pancreatic duct dilation of 4 mm or more in the head of the pancreas or 3 mm or more in the body or tail were included. Digitally recorded EUS images were analyzed for PHS by 1 endoscopist blinded to final results. The final diagnosis was based on pathology results or clinical follow-up. RESULTS: During the study period, 84 of 427 patients who underwent EUS for pancreas pathology had dilated pancreatic ducts. Of these, 42 patients had benign disease and 42 had pancreatic malignancy. The PHS was noted in 31 (73.8%) of 42 patients with malignancy compared with 6 (14.3%) of 42 patients with benign disease (P < .001). The PHS had a sensitivity of 73.8%, a specificity of 85.7%, and an accuracy of 79.8% for the diagnosis of pancreatic malignancy. After adjusting for age, patients with the PHS were 17 times more likely to have a malignancy (odds ratio 16.66; 95% CI, 5.01-55.44). Pancreatic duct diameter or dilation of both bile and pancreatic ducts were not predictive of malignancy. LIMITATION: A retrospective design. CONCLUSIONS: The PHS was an accurate and independent predictor of pancreatic malignancy in patients with a dilated pancreatic duct.

12 Article International consensus guidelines for surgical resection of mucinous neoplasms cannot be applied to all cystic lesions of the pancreas. 2009

Sawhney, Mandeep S / Al-Bashir, Siwar / Cury, Marcelo S / Brown, Alphonso / Chuttani, Ram / Pleskow, Douglas K / Callery, Mark P / Vollmer, Charles M. ·Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. msawhney@bidmc.harvard.edu ·Clin Gastroenterol Hepatol · Pubmed #19577006.

ABSTRACT: BACKGROUND & AIMS: International consensus guidelines, aimed at predicting malignancy, are available for surgical resection of mucinous cysts but not for other cystic lesions of the pancreas. We sought to determine whether the consensus guidelines can be applied to all cystic lesions of the pancreas. METHODS: We identified all patients who underwent surgical resection of pancreatic cysts from 2001-2007. Pathology analyses of surgical specimens served as the reference standard. Surgical resection criteria proposed by the Sendai Guidelines and 5 modifications of these criteria were tested to determine their accuracy for diagnosis of malignant cysts. RESULTS: Patients with cystic lesions of the pancreas (n = 154; mean age, 59.8 years; 64% women) underwent resection and met prespecified study criteria. Twenty-one patients had a malignancy. The classification cyst size > or = 3 cm had an accuracy of 56%, negative predictive value of 84%, and identified only 57% of the malignant cysts. The classification cyst size > or = 3 cm or cyst with main pancreatic duct > or = 10 mm had an accuracy of 55%, negative predictive value of 86%, and identified 66% of malignant cysts. The modified criterion of cyst size > or = 3 cm or cyst with main pancreatic duct > 3 mm had an accuracy of 48%, negative predictive value of 94%, and identified 91% (19/21) of the malignancies. Cyst size (odds ratio, 1.05) and pancreatic duct dilation > 3 mm (odds ratio, 10.5) were strong and independent predictors of malignancy. CONCLUSIONS: When applied to all cystic lesions of the pancreas, the international consensus criteria cause some malignant cysts to be missed. Modified criteria could identify most malignant cysts, although overall accuracy remains low.

13 Article Comparison of carcinoembryonic antigen and molecular analysis in pancreatic cyst fluid. 2009

Sawhney, Mandeep S / Devarajan, Shiva / O'Farrel, Paul / Cury, Marcelo S / Kundu, Rabi / Vollmer, Charles M / Brown, Alphonso / Chuttani, Ram / Pleskow, Douglas K. ·Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. msawhney0@bidmc.harvard.edu ·Gastrointest Endosc · Pubmed #19249035.

ABSTRACT: BACKGROUND: Pancreatic-cyst fluid carcinoembryonic antigen (CEA) levels and molecular analysis are useful diagnostic tests in differentiating mucinous from nonmucinous cysts. OBJECTIVE: To assess agreement between CEA and molecular analysis for differentiating mucinous from nonmucinous cysts. DESIGN: Retrospective analysis. SETTING: Academic medical center. METHODS: Patients who underwent EUS-guided FNA for evaluation of pancreatic cysts were identified. The following information was used to designate a cyst mucinous: the CEA criterion was CEA level >or=192 ng/mL and the molecular analysis criteria were DNA quantity >or=40 ng/microL and/or k-ras 2-point mutation and/or >or=2 allelic imbalance mutations. Pathologic analysis of cysts served as the criterion standard. RESULTS: From 2006 to 2007, 100 patients met the study criteria. The average age of the patients was 63 years, 65% were women, and 30% were symptomatic. The mean diameter of pancreatic cysts was 2.5 cm. The median CEA value was 83 ng/mL (range 1-50,000 ng/mL), the mean DNA content was 16 ng/microL (range 1-212 ng/microL), 11% had K-ras mutations, and 43% had >or=2 allelic imbalance mutations. When using prespecified criteria, there was poor agreement between CEA and molecular analysis for the classification of mucinous cysts (kappa = 0.2). Poor agreement existed between CEA and DNA quantity (Spearman correlation = 0.2; P = .1), K-ras mutation (kappa = 0.3), and >or=2 allelic imbalance mutations (kappa = 0.1). Of the 19 patients for whom a final pathologic diagnosis was available, CEA had a sensitivity of 82% compared with 77% for molecular analysis. When CEA and molecular analysis were combined, 100% sensitivity was achieved. LIMITATIONS: Retrospective analysis and small sample size. CONCLUSION: There was poor agreement between CEA levels and molecular analysis for diagnosis of mucinous cysts. Diagnostic sensitivity was improved when results of CEA levels and molecular analysis were combined.