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1. Hemostatic spray (TC-325) vs. standard endoscopic therapy for non-variceal gastrointestinal bleeding: A meta-analysis of randomized controlled trials

Author

Smit S. Deliwala, Saurabh Chandan, Babu P. Mohan, Shahab Khan, Nitin Reddy, Daryl Ramai, Jay A. Bapaye, Dushyant Singh Dahiya, Lena L. Kassab, Antonio Facciorusso, Saurabh Chawla, and Douglas Adler

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and study aims Hemospray (TC-325) is a mineral powder with adsorptive properties designed for use in various gastrointestinal bleeding (GIB) scenarios. We conducted a systematic review & meta-analysis of randomized controlled trials (RCTs) comparing TC-325 to standard endoscopic therapy (SET) for non-variceal GIB (NVGIB). Methods Multiple databases were searched through October 2022. Meta-analysis was performed using a random-effects model to determine pooled relative risk (RR) and proportions with 95 % confidence intervals (CI) for primary hemostasis, hemostasis failure, 30-day rebleeding, length of stay (LOS), and need for rescue interventions. Heterogeneity was assessed using I2%. Results Five RCTs with 362 patients (TC-325 178, SET 184) – 123 females and 239 males with a mean age 65 ± 16 years). The most common etiologies were peptic ulcer disease (48 %), malignancies (35 %), and others (17 %). Bleeding was characterized as Forrest IA (7 %), IB (73 %), IIA (3 %), and IIB (1 %). SET included epinephrine injection, electrocautery, hemoclips, or a combination. No statistical difference in primary hemostasis between TC-325 compared to SET, RR 1.09 (CI 0.95–1.25; I2 43), P = 0.2, including patients with oozing/spurting hemorrhage, RR 1.13 (CI 0.98–1.3; I2 35), P = 0.08. Failure to achieve hemostasis was higher in SET compared to TC-325, RR 0.30 (CI 0.12–0.77, I2 0), P = 0.01, including patients with oozing/spurting hemorrhage, RR 0.24 (CI 0.09 – 0.63, I2 0), P = 0.004. We found no difference between the two interventions in terms of rebleeding, RR 1.13 (CI 0.62–2.07, I2 26), P = 0.8 and LOS, standardized mean difference (SMD) 0.27 (CI, –0.20–0.74; I2 62), P = 0.3. Finally, pooled rate of rescue interventions (angiography) was statistically higher in SET compared to TC-325, RR 0.68 (CI 0.5–0.94; I2 0), P = 0.02. Conclusions Our analysis shows that for acute NV GIB, including oozing/spurting hemorrhage, TC-325 does not result in higher rates of primary hemostasis compared to SET. However, lower rates of failures were seen with TC-325 than SET. In addition, there was no difference in the two modalities when comparing rates of rebleeding and LOS.

Published
2023
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2. Endoscopic retrograde appendicitis therapy for acute appendicitis: a systematic review and meta-analysis

Author

Banreet Dhindsa, Yassin Naga, Alexander Praus, Syed Mohsin Saghir, Harmeet Mashiana, Daryl Ramai, Saurabh Chandan, Harlan Sayles, Amaninder Dhaliwal, Ishfaq Bhat, Shailender Singh, and Douglas Adler

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and study aims Endoscopic retrograde appendicitis therapy (ERAT) is an endoscopic procedure for management of patients with acute appendicitis (AA). In addition to being minimally invasive, it has the added advantages of preservation of appendix and simultaneous inspection of colon. We performed a systematic review and meta-analysis on ERAT in patients with AA. Methods We conducted a comprehensive search of multiple electronic databases (from inception through January 2022) to identify studies reporting ERAT in AA. The primary outcome was to evaluate the overall clinical and technical success of ERAT. The secondary outcome was to study the total and individual adverse events (AEs). The meta-analysis was performed using Der Simonian and Laird random effect model. Results Seven studies reporting on 298 patients were included. The majority of the patient population was male (55.3 %), with mean age of 31 ± 12.39 years. The pooled technical success rate was 99.36 % (95 % CI 97.61–100, I2 = 0) and the pooled clinical success rate was 99.29 % (95 % CI 97.48–100, I2 = 0). The pooled AE rate was 0.19 % (95 % CI 0–1.55, I2 = 0). The most common AE was perforation with 0.19 % (95 % CI 0–1.55, I2 = 0). The recurrence rate was 6.01 % (95 % CI 2.9–9.93, I2 = 20.10). Average length of procedure was 41.1 ± 7.16 min. Low heterogeneity was noted in in our meta-analysis. Conclusions ERAT is a safe procedure with high rates of clinical and technical success in patients with AA. Further randomized controlled trials should be performed to assess the utility of ERAT in AA as compared to laparoscopic appendectomy.

Published
2022
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3. EUS-guided fine-needle core liver biopsy with a modified one-pass, one-actuation wet suction technique comparing two types of EUS core needles

Author

Jose Nieto, Enad Dawod, Ameya Deshmukh, Eli Penn, Douglas Adler, and Sammy Saab

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and study aims We compared the diagnostic yield and specimen adequacy in EUS-guided parenchymal biopsies between two types of EUS 19 G core needles. Patients and methods This is a retrospective study of 420 patients at two tertiary medical centers in Florida with unexplained abnormal liver associated tests were referred for EUS evaluation of biliary obstruction and pancreatic pathology. EUS-guided liver biopsy (EUS-LB) was performed at the same session after biliary obstruction was excluded. We compared intact specimen length (ISL), total specimen length (TSL), complete portal triads (CPT) and adverse events (AE). Welch’s T and Tukey tests were used for ISL, TSL and CPT. Results A total of 210 patients underwent EUS-LB using a Franseen needle, 210 patients using a fork-tip needle. Median patient age was 52 years (15.63) and 238 (56.7 %) were female. The fork-tip needle had a mean ISL of 2.7 (1.1 SD) cm, TSL of 6 cm (2.1 SD), and mean 19.5 CPT (8.5 SD) Abdominal pain occurred in 35 patients (17 %) post-procedure and was managed with supportive care. Two patients required intravenous (IV) narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) patients. The Franseen needle had a mean ISL of 3.1 cm (1.3 SD), TSL of 6.5 cm (2.6 SD), and mean of 24 CPT (8.8 SD). Abdominal pain occurred in four patients (2 %) post-procedure, which resolved in all patients after IV narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) and bile leak in 1(0.4 %) patients. Conclusions Use of the Franseen needle resulted in better liver core samples than that obtained with a fork-tip needle.

Published
2020
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4. Hemostatic spray (TC-325) vs. standard endoscopic therapy for non-variceal gastrointestinal bleeding: A meta-analysis of randomized controlled trials

Author

Saurabh Chandan, Smit S. Deliwala, Babu P. Mohan, Shahab Khan, Nitin Reddy, Daryl Ramai, Jay A. Bapaye, Dushyant Singh Dahiya, Lena L. Kassab, Antonio Facciorusso, Saurabh Chawla, and Douglas Adler

Subjects
Pharmacology (medical)
Abstract

Background and study aims Hemospray (TC-325) is a mineral powder with adsorptive properties designed for use in various gastrointestinal bleeding (GIB) scenarios. We conducted a systematic review & meta-analysis of randomized controlled trials (RCTs) comparing TC-325 to standard endoscopic therapy (SET) for non-variceal GIB (NVGIB). Methods Multiple databases were searched through October 2022. Meta-analysis was performed using a random-effects model to determine pooled relative risk (RR) and proportions with 95 % confidence intervals (CI) for primary hemostasis, hemostasis failure, 30-day rebleeding, length of stay (LOS), and need for rescue interventions. Heterogeneity was assessed using I2%. Results Five RCTs with 362 patients (TC-325 178, SET 184) – 123 females and 239 males with a mean age 65 ± 16 years). The most common etiologies were peptic ulcer disease (48 %), malignancies (35 %), and others (17 %). Bleeding was characterized as Forrest IA (7 %), IB (73 %), IIA (3 %), and IIB (1 %). SET included epinephrine injection, electrocautery, hemoclips, or a combination. No statistical difference in primary hemostasis between TC-325 compared to SET, RR 1.09 (CI 0.95–1.25; I2 43), P = 0.2, including patients with oozing/spurting hemorrhage, RR 1.13 (CI 0.98–1.3; I2 35), P = 0.08. Failure to achieve hemostasis was higher in SET compared to TC-325, RR 0.30 (CI 0.12–0.77, I2 0), P = 0.01, including patients with oozing/spurting hemorrhage, RR 0.24 (CI 0.09 – 0.63, I2 0), P = 0.004. We found no difference between the two interventions in terms of rebleeding, RR 1.13 (CI 0.62–2.07, I2 26), P = 0.8 and LOS, standardized mean difference (SMD) 0.27 (CI, –0.20–0.74; I2 62), P = 0.3. Finally, pooled rate of rescue interventions (angiography) was statistically higher in SET compared to TC-325, RR 0.68 (CI 0.5–0.94; I2 0), P = 0.02. Conclusions Our analysis shows that for acute NV GIB, including oozing/spurting hemorrhage, TC-325 does not result in higher rates of primary hemostasis compared to SET. However, lower rates of failures were seen with TC-325 than SET. In addition, there was no difference in the two modalities when comparing rates of rebleeding and LOS.

Published
2023
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6. Students' Conceptions about Climate Change: Using Critical Evaluation to Influence Plausibility Reappraisals and Knowledge Reconstruction

Author

Lombardi, Douglas Adler

Abstract

The Intergovernmental Panel on Climate Change (2007) reported a greater than 90% chance that human activities are responsible for global temperature increases over the last 50 years, as well as other climatic changes. The scientific report also states that alternative explanations (e.g., increasing energy received from the Sun) are less plausible than human-induced climate change. These climate scientists have made their plausibility judgment--which I define as the relative potential truthfulness of alternative explanations--based on the evaluation and coordination of multiple lines evidence with competing theoretical perspectives. Climate change is a highly relevant and gravely serious topic; in an educational setting, climate change also presents an opportunity for students to learn about fundamental scientific principles and how scientists construct knowledge. However, students may be neither naturally evaluative when learning about controversial topics, such as climate change, nor reflective while engaging in judgments about knowledge and knowing (King & Kitchener, 2004), such as plausibility judgments. The purpose of this study was to examine how plausibility judgments and knowledge about human-induced climate change transform during instruction that promotes critical evaluation abilities. An instructional scaffold--called a model evidence link (MEL) diagram--was used in this study. The MEL allowed students to weigh the strength of connections between two alternative models of climate change (i.e., the scientifically accepted model of human-induced climate change and a popular skeptics' model that climate change is caused by increases in the Sun's energy). The results revealed that treatment group participants who used the MEL diagram experienced a significant shift in their plausibility judgments toward the scientifically accepted model. This shift was accompanied by significantly greater postinstructional knowledge of human-induced climate change, with treatment group participants demonstrating reconstruction of knowledge about the causes of climate change to be more consistent with scientific understanding. Moderate to large effect sizes characterized these changes in treatment group participants' plausibility perceptions and understanding. A comparison group of students who experienced a climate change activity that is part of their normal curriculum did not experience statistically significant changes. The results from this dissertation study, along with previous studies that I and my colleagues have conducted (see, for example, Lombardi & Sinatra, 2012), helped to inform the development of a model on the role of the plausibility judgment in conceptual change. This model has the potential to guide further research that will help educators better understand the mechanisms in conceptual change and guide instructional practices to promote knowledge reconstruction on scientific topics of great societal importance, such as climate change. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Published
2012

7. Endoscopic retrograde appendicitis therapy for acute appendicitis: a systematic review and meta-analysis

Author

Banreet Dhindsa, Yassin Naga, Alexander Praus, Syed Mohsin Saghir, Harmeet Mashiana, Daryl Ramai, Saurabh Chandan, Harlan Sayles, Amaninder Dhaliwal, Ishfaq Bhat, Shailender Singh, and Douglas Adler

Subjects
Pharmacology (medical)
Abstract

Background and study aims Endoscopic retrograde appendicitis therapy (ERAT) is an endoscopic procedure for management of patients with acute appendicitis (AA). In addition to being minimally invasive, it has the added advantages of preservation of appendix and simultaneous inspection of colon. We performed a systematic review and meta-analysis on ERAT in patients with AA. Methods We conducted a comprehensive search of multiple electronic databases (from inception through January 2022) to identify studies reporting ERAT in AA. The primary outcome was to evaluate the overall clinical and technical success of ERAT. The secondary outcome was to study the total and individual adverse events (AEs). The meta-analysis was performed using Der Simonian and Laird random effect model. Results Seven studies reporting on 298 patients were included. The majority of the patient population was male (55.3 %), with mean age of 31 ± 12.39 years. The pooled technical success rate was 99.36 % (95 % CI 97.61–100, I2 = 0) and the pooled clinical success rate was 99.29 % (95 % CI 97.48–100, I2 = 0). The pooled AE rate was 0.19 % (95 % CI 0–1.55, I2 = 0). The most common AE was perforation with 0.19 % (95 % CI 0–1.55, I2 = 0). The recurrence rate was 6.01 % (95 % CI 2.9–9.93, I2 = 20.10). Average length of procedure was 41.1 ± 7.16 min. Low heterogeneity was noted in in our meta-analysis. Conclusions ERAT is a safe procedure with high rates of clinical and technical success in patients with AA. Further randomized controlled trials should be performed to assess the utility of ERAT in AA as compared to laparoscopic appendectomy.

Published
2021

8. Self-Expanding Stents in Gastrointestinal Endoscopy

Author

Douglas Adler and Douglas Adler

Subjects
RC803
Abstract

There is a tremendous interest in information on stents in the world of gastrointestinal endoscopy. Many physicians did not train in an era where these stents were available, but are now being called upon to place them. Self-Expanding Stents in Gastrointestinal Endoscopy looks to provide physicians with the necessary and unique all-in-one resource on stents.Self-Expanding Stents in Gastrointestinal Endoscopy by Dr. Douglas G. Adler covers the use of self-expanding stents. This book will cover the use of all available devices in all clinical contexts, with step-by-step instructions from experts in the field on how to use them and, just as importantly, what not to do when using these devices. Self-Expanding Stents in Gastrointestinal Endoscopy is illustrated with more than 150 color photographs, as well as many tables and diagrams.Benefits and Features: Soup-to-nuts format covers the use of all devices available on the market in all clinical situations All chapters authored by recognized experts in the world of stents who have independently published extensive research in gastrointestinal endoscopy Over 150 color photographs to guide readers from start to finish through all steps of learning about the procedures Self-Expanding Stents in Gastrointestinal Endoscopy brings attention to the use of self-expanding stents in benign and malignant diseases, the avoidance and management of complications, and the future of these devices.Self-Expanding Stents in Gastrointestinal Endoscopy is the perfect go-to book for all practicing gastroenterologists, fellows, and general and colorectal surgeons.

Published
2024

9. Curbside Consultation in GI Cancer for the Gastroenterologist : 49 Clinical Questions

Author

Douglas Adler and Douglas Adler

Subjects
Digestive organs--Cancer, Gastrointestinal Neoplasms--diagnosis, Gastrointestinal Neoplasms--therapy
Abstract

Are you looking for concise, practical answers to questions that are often left unanswered by traditional cancer references that are not designed for gastroenterologists? Are you seeking brief, evidence-based advice for complicated cases or patients with complications that need management? Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a “curbside consultation” between colleagues.Dr. Douglas G. Adler has designed this unique reference, which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with GI cancer. The unique Q&A format provides quick access to current information related to GI cancer with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the treatment of GI cancer patients.Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Gastroenterologists, fellows and residents in training, surgical attendings, and surgical residents will benefit from the user-friendly and casual format and the expert advice contained within.Some of the questions that are answered:• An 81-year-old man is found to have unresectable esophageal cancer and malignant dysphagia. Should he have a stent? A nasogastric feeding tube? A PEG tube?• How is tumor-related bleeding from gastric cancers best approached?• Do patients with pancreatic cancer and jaundice need to have an ERCP preoperatively?• What is the role of ERCP and EUS in patients with suspected cholangiocarcinoma?• Why are rectal cancers so different from colon cancers with regards to medical and surgical management?Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions illustrates how patients at different points in their treatment may go back and forth between specialists to receive coordination of care, and incorporates input from gastroenterologists, surgeons, radiologists, and oncologists. While providing up-to-date information, this book will help gastroenterologists to manage complex cancer-related issues and guide physicians through the maze of cancer-related treatments available.Ideal for practicing gastroenterologists, gastroenterology fellows, surgeons, oncologists, residents, and medical students, Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions is sure to benefit anyone caring for patients with gastrointestinal cancers.

Published
2024

10. Understanding curriculum as geo/biospheric text

Author

Sandra A. Scott, Douglas Adler, and Fay Bigloo

Subjects
Inclusion, Greatness, Understanding, Profit (real property), Inclusion (disability rights), Ecology, Viewpoints/ Controversies, media_common.quotation_subject, 05 social sciences, 050301 education, Environmental ethics, 030229 sport sciences, Lived experience, Education, Nationalism, Populism, 03 medical and health sciences, 0302 clinical medicine, Political science, Famine, Curriculum, Consciousness, 0503 education, media_common
Abstract

The world is experiencing crises related to the cascading effects of anthropization. These crises result from imperialist and capitalist practices that categorize and exploit the other (e.g., the land, the water, and their resources and beings) for maximizing profit. Such malpractices have led to climate crises of drought, famine, and extinctions. In the present, things are categorized through detachment, whereby the self-absorbed hyperbolic sees greatness in being and acting in meager ways, in nationalism and populism. In the midst of experiencing such a world of isms, this article suggests an important change for education—a curricular adjustment that not only allows for addressing subject matter (i.e., health and economics) and the subjects of such matters (i.e., the students and the teachers in the classrooms) but also acknowledges the importance of the other (i.e., the non-human world), which has been at the mercy of a singular reliance on the “incomplete” human consciousness. An inclusive curriculum underscores the different forms of concrete conscious beings and is mindful of a togetherness that ensures the continuation of life. “Event-ually”, through highlighting each individual with the natural environment, the latent bonds each individual has with the other and another, and with the world itself, will expose themselves in new ways.

Published
2021

11. The Little GI Book : An Easily Digestible Guide to Understanding Gastroenterology

Author

Douglas Adler and Douglas Adler

Subjects
Gastrointestinal Diseases--therapy, Gastrointestinal Diseases--diagnosis
Abstract

A practical, portable handbook, newly updated with nearly 100 color images and figures, The Little GI Book: An Easily Digestible Guide to Understanding Gastroenterology, Second Edition is an invaluable resource for anyone new to the world of gastroenterology and hepatology. Featuring new information on the latest advancements in gastroenterology and hepatology and written in a friendly, conversational style, The Little GI Book will help readers learn the core concepts of digestive health and disease and absorb important information without a hiccup. Author Dr. Douglas G. Adler provides a comprehensive, soup-to-nuts guide to gastrointestinal anatomy, physiology, disease states, and treatment. With new color images throughout, The Little GI Book guides the reader through the entire gastrointestinal tract, starting at the top with the esophagus, ending at the bottom with the colon and rectum, and covering everything in between: the stomach, small intestine, liver, pancreas, bile ducts, and gallbladder.The Little GI Book is an indispensable pocket guide for residents, students, nurse practitioners, office staff, industry sales force, and anyone who works in the GI industry but isn't a gastroenterologist.

Published
2020

12. Core Concepts in Colonoscopy

Author

Douglas Adler and Douglas Adler

Abstract

Core Concepts in Colonoscopy covers all aspects of diagnostic and therapeutic colonoscopy, emphasizing overarching concepts that gastroenterology fellows and physicians must know to achieve success in both the technical and cognitive aspects of the procedure. In this comprehensive resource, Dr. Douglas G. Adler and his contributors provides a straightforward and practical review of colonoscopy.Core Concepts in Colonoscopy aims to address and convey the core concepts of colonoscopy: from the structure and function of the colonoscope itself, to insertion techniques, loop formation and reduction, polypectomy techniques for any situation, the avoidance and management of perforations and other adverse events, as well as advanced techniques including (but not limited to) endoscopic mucosal resection and colonic stenting.Each chapter inside Core Concepts in Colonoscopy is lavishly illustrated with multiple key images to accentuate and enhance the written text, as well as a plethora of tips, tricks, and accumulated points of wisdom in each chapter on all facets of colonoscopy.Additional Website Component!Core Concepts in Colonoscopy is accompanied by a video website with specific videos connected to individual chapters that will illustrate basic and advanced colonoscopic techniques from many leading experts and will further enhance the learning process. The addition of the video website allows for a more robust learning experience and allows the reader to watch, listen, view repeatedly, and reinforces the techniques presented in the written text.GI fellows, junior gastroenterologists, and even advanced physicians will appreciate Core Concepts in Colonoscopy because of the user-friendly and efficient structure that allows for the material to be quickly read, as well as easily absorb the wealth of key practical knowledge found inside.

Published
2014

13. The Little GI Book : An Easily Digestible Guide to Understanding Gastroenterology

Author

Douglas Adler and Douglas Adler

Subjects
Gastrointestinal system--Diseases
Abstract

What's the difference between a subtotal colectomy and a total proctocolectomy? How can you tell if a patient has cirrhosis? If a patient is jaundiced, should you order an ultrasound, an MRI scan, or an ERCP? The Little GI Book: An Easily Digestible Guide to Understanding Gastroenterology answers these questions and more. Primarily designed for those new to the world of gastroenterology and hepatology, The Little GI Book will help you learn the core concepts of digestive health and disease while on the go. Portable and handy, this conversational-style book packs a big punch! The Little GI Book will prove invaluable to residents, students, nurse practitioners, office staff, industry sales force, and anyone who works in the GI industry but isn't a gastroenterologist. Since gastroenterology as a specialty involves many organs, Dr. Douglas G. Adler uses a novel organ-based approach to give a comprehensive, soup-to-nuts “field guide” to gastrointestinal anatomy, physiology, disease states, and treatment. The Little GI Book guides the reader through the entire gastrointestinal tract, starting at the top with the esophagus, ending at the bottom with the colon and rectum, and covering everything in between: the stomach, small intestine, liver, pancreas, bile ducts, and gallbladder. Written in a friendly, relaxed style and illustrated with over 50 key images and figures, The Little GI Book helps cement important concepts without a hiccup. Readers can approach the material without fear, and even have fun learning!

Published
2013

14. Peroral cholangioscopy facilitates targeted tissue acquisition in patients with suspected cholangiocarcinoma

Author

Liu, R., Cox, K., Siddiqui, A., Feurer, M., Baron, T. H., and Douglas Adler

Subjects
Cholangiopancreatography, Endoscopic Retrograde, Male, Biopsy, Reproducibility of Results, Constriction, Pathologic, Middle Aged, Sensitivity and Specificity, Endoscopy, Gastrointestinal, Cholangiocarcinoma, Diagnosis, Differential, Bile Ducts, Intrahepatic, Bile Duct Neoplasms, Predictive Value of Tests, Humans, Female, Endoscopy, Digestive System, Aged, Retrospective Studies
Abstract

Biliary strictures that are suspicious for cholangiocarcinoma (CCA) are commonly encountered in clinical practice in patients with and without primary sclerosing cholangitis (PSC). A definitive histologic diagnosis of CCA via endoscopic retrograde cholangiography (ERCP) is often not obtainable with standard biliary brush cytology. Peroral cholangioscopy is an additional tool to help provide a diagnosis of CCA in patients with suspicious biliary strictures. Aim of the study was to assess the use of peroral cholangioscopy in patients with and without PSC and indeterminate biliary strictures.Retrospective study.25 patients were included in the study. All patients underwent ERCP with peroral cholangioscopy. Tissue samples obtained included routine cytology, fluorescent in-situ hybridization, and cholangioscopic-directed forceps biopsies. The operating characteristics of cholangioscopy to detect malignancy in 18 PSC patients with suspected cholangiocarcinoma were a sensitivity of 75%, specificity of 55%, and a positive predictive value (PPV) of 23%, and a negative predictive value of 92%. In 7 non-PSC patients with suspected cholangiocarcinoma these values sensitivity=100%, 25%, 50%, and NPV=100%, respectively. The overall operating characteristics of cholangioscopy to detect malignancy in all 25 patients with suspected cholangiocarcinoma were: sensitivity of 86%, specificity of 50%, PPV of 32%, and NPV of 93%.Cholangioscopy helps identify sites for tissue acquisition in PSC and non-PSC patients with biliary strictures suspicious for malignancy.

Published
2014

15. Self-Expanding Stents in Gastrointestinal Endoscopy

Author

Douglas Adler and Douglas Adler

Abstract

There is a tremendous interest in information on stents in the world of gastrointestinal endoscopy. Many physicians did not train in an era where these stents were available, but are now being called upon to place them. Self-Expanding Stents in Gastrointestinal Endoscopy looks to provide physicians with the necessary and unique all-in-one resource on stents. Self-Expanding Stents in Gastrointestinal Endoscopy by Dr. Douglas G. Adler covers the use of self-expanding stents. This book will cover the use of all available devices in all clinical contexts, with step-by-step instructions from experts in the field on how to use them and, just as importantly, what not to do when using these devices. Self-Expanding Stents in Gastrointestinal Endoscopy is illustrated with more than 150 color photographs, as well as many tables and diagrams.Benefits and Features:· Soup-to-nuts format covers the use of all devices available on the market in all clinical situations· All chapters authored by recognized experts in the world of stents who have independently published extensive research in gastrointestinal endoscopy· Over 150 color photographs to guide readers from start to finish through all steps of learning about the proceduresSelf-Expanding Stents in Gastrointestinal Endoscopy brings attention to the use of self-expanding stents in benign and malignant diseases, the avoidance and management of complications, and the future of these devices.Self-Expanding Stents in Gastrointestinal Endoscopy is the perfect go-to book for all practicing gastroenterologists, fellows, and general and colorectal surgeons.

Published
2012

16. Double balloon enteroscopy: is it efficacious and safe in a community setting?

Author

Sa, Sorser, Watson A, Rm, Gamarra, Le, Stawick, and Douglas Adler

Subjects
Double-Balloon Enteroscopy, Male, Intestinal Diseases, Humans, Female, Community Health Centers, Middle Aged
Abstract

Double balloon enteroscopy (DBE) has been extensively used in tertiary referral centers but little literature exists on the efficacy, complications and outcomes of patients undergoing DBE in the community setting. We present our findings regarding the use of DBE in a community hospital.From March 2007 to January 2011, 88 DBE procedures were performed on 66 patients. Indications included evaluation anemia/gastrointestinal bleed, small bowel IBD and dilation of strictures. Video-capsule endoscopy (VCE) was used prior to DBE in 43 of the 66 patients prior to DBE evaluation.The mean age was 62 years. Thirty-two patients were female, 15 were African-American; 44 antegrade and 44 retrograde DBEs were performed. The mean time per antegrade DBE was 107.4±30.0 minutes with a distance of 318.4±152.9 cm reached past the pylorus. The mean time per lower DBE was 100.7±27.3 minutes with 168.9±109.1 cm meters past the ileocecal valve reached. Endoscopic therapy in the form of electrocautery to ablate bleeding sources was performed in 20 patients (30.3%), biopsy in 17 patients (25.8%) and dilation of Crohn's-related small bowel strictures in 4 (6.1%). 43 VCEs with pathology noted were performed prior to DBE, with findings endoscopically confirmed in 32 cases (74.4%). In 3 cases the DBE showed findings not noted on VCE.DBE appears to be equally safe and effective when performed in the community setting as compared to a tertiary referral center with a comparable yield, efficacy, and complication rate.

Published
2013

17. Curbside Consultation in GI Cancer for the Gastroenterologist : 49 Clinical Questions

Author

Douglas Adler and Douglas Adler

Abstract

Are you looking for concise, practical answers to questions that are often left unanswered by traditional cancer references that are not designed for gastroenterologists? Are you seeking brief, evidence-based advice for complicated cases or patients with complications that need management? Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a “curbside consultation” between colleagues.Dr. Douglas G. Adler has designed this unique reference, which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with GI cancer. The unique Q&A format provides quick access to current information related to GI cancer with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the treatment of GI cancer patients.Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Gastroenterologists, fellows and residents in training, surgical attendings, and surgical residents will benefit from the user-friendly and casual format and the expert advice contained within.Some of the questions that are answered:• An 81-year-old man is found to have unresectable esophageal cancer and malignant dysphagia. Should he have a stent? A nasogastric feeding tube? A PEG tube?• How is tumor-related bleeding from gastric cancers best approached?• Do patients with pancreatic cancer and jaundice need to have an ERCP preoperatively?• What is the role of ERCP and EUS in patients with suspected cholangiocarcinoma?• Why are rectal cancers so different from colon cancers with regards to medical and surgical management?Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions illustrates how patients at different points in their treatment may go back and forth between specialists to receive coordination of care, and incorporates input from gastroenterologists, surgeons, radiologists, and oncologists. While providing up-to-date information, this book will help gastroenterologists to manage complex cancer-related issues and guide physicians through the maze of cancer-related treatments available.Ideal for practicing gastroenterologists, gastroenterology fellows, surgeons, oncologists, residents, and medical students, Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions is sure to benefit anyone caring for patients with gastrointestinal cancers.

Published
2011

18. Modulation of SPARC Expression during Butyrate-Induced Terminal Differentiation of Cultured Human Keratinocytes: Regulation via a TGF-β-Dependent Pathway

Author

Peter Racanelli, Lisa Staiano-Coico, Renee Ford, Paul J. Higgins, Geng Wang, Douglas Adler, and Parissa Jannati

Subjects
Keratinocytes, Time Factors, Biology, Antibodies, Methionine, Transforming Growth Factor beta, Gene expression, medicine, Extracellular, Humans, Electrophoresis, Gel, Two-Dimensional, Osteonectin, Autocrine signalling, Cells, Cultured, Extracellular Matrix Proteins, Cell Cycle, Cell Differentiation, Cell Biology, Cell cycle, Immunohistochemistry, Molecular biology, Fibronectin, Butyrates, Kinetics, medicine.anatomical_structure, Cell culture, Immunology, biology.protein, Butyric Acid, Electrophoresis, Polyacrylamide Gel, Keratinocyte, Transforming growth factor
Abstract

Expression of SPARC (secreted protein acidic and rich in cysteine), a 43-kDa extracellular matrix-associated glycoprotein involved in tissue remodeling, was quantitated during normal human keratinocyte (NHK) growth in culture and as a function of sodium n-butyrate (NaB)-induced differentiation to mature enucleate cornified envelopes (CEs). Low levels of SPARC expression were observed in the basal-like cells of control NHKs, with isolated cells showing intense SPARC expression on the ventral surface. After addition of NaB, SPARC expression increased and the pattern of expression shifted to one involving predominantly suprabasal cells (i.e., spinous cells, pre-CEs, and mature CEs). Dense deposits of SPARC often surrounded the mature CEs. Flow cytometric analysis indicated that approximately 13% of NHKs expressed SPARC within 24 h of seeding into culture. This fraction of SPARC+ cells increased with time and peaked immediately postconfluence (31.3 +/- 6.3% SPARC+). Cellular SPARC expression then decreased to baseline levels during entrance into plateau phase growth. SPARC was detectable in all phases of the cell cycle. SPARC levels were more intense and heterogeneous within the G2/M and G1 phases while S phase cells exhibited relatively homogeneous, low intensity, SPARC expression. During NaB-induced NHK differentiation, SPARC intracellular content increased prior to the onset of CE formation (i.e., 2 days after its addition) followed by a period of extracellular accumulation which coincided with the time of maximal CE generation (i.e., Days 4 and 5 after NaB addition). Correlation of cell size with anti-SPARC immunoreactivity revealed a predominance of SPARC expression in cells with a suprabasal phenotype. NHKs cultured on fibronectin (FN), an established modulator of epidermal cell maturation in vitro, showed a similar response to NaB. In general, however, the level of NaB-induced SPARC expression was considerably reduced in FN cultures correlating with a lower efficiency of CE formation. Induced SPARC expression was, in large part, dependent on autocrine transforming growth factor-beta (TGF-beta) production since incubation in the presence of NaB+neutralizing antibodies to TGF-beta inhibited both the expression of SPARC by 72% and development of mature CEs.

Published
1993
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20. Identification and Screening of Individuals at Increased Risk for Pancreatic Cancer with Emphasis on Known Environmental and Genetic Factors and Hereditary Syndromes

Author

Chu, D., Kohlmann, W., and Douglas Adler

Subjects
Adenocarcinoma, Early Detection of Cancer, Neoplastic Syndromes, Hereditary, Pancreatic Neoplasms, Risk Factors
Abstract

Despite recent diagnostic and therapeutic advances, pancreatic cancer still carries a poor prognosis. Screening high-risk individuals is a relatively new concept with regards to pancreatic cancer but is an area of intense study. Significant effort has been invested in identifying risk factors for pancreatic cancer. Risk factors for pancreatic cancer can be classified into three broad categories: demographic, environmental (host), and hereditary (genetic) predisposition. This manuscript will review the risk factors and genetic syndromes associated with increased risk of developing pancreatic cancer, the role of genetic testing in the evaluation of high-risk patients, the available serologic and imaging tests that can be used to screen these individuals, and will summarize the available literature on attempts at pancreatic cancer screening to date. Image: Logo of Huntsman Cancer Center, University of Utah School of Medicine. Salt Lake City, UT, USA, JOP. Journal of the Pancreas, Vol 11, No 3 (2010): May - p. 199-298

Published
2010
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22. 40. Levitating vitrified droplets

Author

Raymond M. Anchan, Young S. Song, Utkan Demirci, Aida Nureddin, Hasan Onur Keles, Richard L. Maas, Douglas Adler, and Emre Kayaalp

Subjects
General Medicine, General Agricultural and Biological Sciences, General Biochemistry, Genetics and Molecular Biology
Published
2009
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23. Response

Author

Douglas Adler

Subjects
Gastroenterology, Radiology, Nuclear Medicine and imaging
Published
2007
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25. Retrievable Esophageal Stents for Benign Indications.

Author

Robert Wong, Douglas Adler, Kristen Hilden, and John Fang

Subjects
*HUMAN abnormalities, *SURGICAL stents, *FISTULA, *HOLES
Abstract

Abstract  Until recently, esophageal stents have not been a realistic option for the management of benign disease owing to difficulty removing the stents and associated high complication rates. However, progress in esophageal stent design has led to the development of retrievable esophageal stents. Clinical experience has shown promise for the management of benign esophageal diseases with retrievable stents, including refractory strictures, esophageal leaks, fistula and perforations. They have been shown to be safe and effective, though stent migration remains a concern. This article reviews the current designs, indications, efficacy and complications of retrievable esophageal stents. [ABSTRACT FROM AUTHOR]

Published
2008
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35. Investigation of gonadal markers in cystic pancreatic lesions: A pilot study

Author

Gorman D, Rf, Wong, Hilden K, and Douglas Adler

Subjects
Adult, Aged, 80 and over, Male, Cystadenoma, Serous, Pilot Projects, Middle Aged, Suction, Cystadenocarcinoma, Mucinous, Cystadenoma, Papillary, Sensitivity and Specificity, Pancreatic Neoplasms, Predictive Value of Tests, Cystadenoma, Mucinous, Pancreatic Pseudocyst, Biomarkers, Tumor, Humans, Female, Inhibins, Pancreatic Cyst, Aged

37. A protocol for modeling atmospheric transport and deposition of acidic species in East Tennessee using MESOPUFF II

Author

Lombardi, Douglas Adler

Abstract

A modeling protocol for estimating atmospheric concentrations and deposition of acidic species resulting from new emission sources or major modifications to existing sources located in East Tennessee has been developed and demonstrated. The protocol is based on the MESOPUFF II air dispersion model and was developed primarily for evaluating acidic deposition in areas that have special protection from the adverse impacts caused by air pollution (i.e., the Great Smoky Mountains National Park, Joyce Kilmer Wilderness Area, and Cohutta Wilderness Area). Wind fields were created over the modeling domain using 1990 meteorological data from multiple stations. Adjustments were made to the model's meteorological preprocessor to simulate the up- and down-valley wind flow in the mixed layer over East Tennessee. The preprocessor was also modified to smooth an otherwise discontinuous wind field. Model runs simulating emissions from a 28.8 g/s (1000 tpy) source were made. The hypothetical source was sited at four locations; (1) Knoxville/McGhee Tyson Airport, (2) Bristol/Tri Cities Airport, (3) Chattanooga/Lovell Field, and (4) Crossville. The Knoxville source resulted in the highest concentration and deposition values in the Great Smoky Mountains National Park and Joyce Kilmer Wilderness Area. The Chattanooga source resulted in the highest concentration and deposition values in Cohutta Wilderness Area. Sensitivity runs made for August 1990 show that estimated concentration and deposition values are linearly proportional to emission rate. These runs also show that changes in stack height result in relatively minor differences in maximum deposition estimates. Based on these results, maps of deposition potential were constructed. These maps may be used as screening tools to provide a first approximation of maximum deposition on the Great Smoky Mountains National Park, Joyce Kilmer Wilderness Area, and Cohutta Wilderness area from any location in East Tennessee.

Published
1996

38. Endoscopic dilation of small-intestine strictures in Crohn's disease by balloon-assisted enteroscopy: a systematic review and meta-analysis.

Author

Moond V, Gill VJS, Malik S, Kasture A, Parajuli S, Soni S, Chandan S, Broder A, Mohan BP, and Adler D

Abstract

Background: Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn's disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD., Methods: We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied using I 2 statistics., Results: We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5; I 2 =53%) and the pooled therapeutic success rate was 69.7% (95%CI 61.6-76.7; I 2 =71%). The pooled major complications per procedure were 5.5% (95%CI 3.5-8.4; I 2 =57%); the risk of bleeding was 2.5% (95%CI 1.4-4.2; I 2 =28%), and the risk of perforation was 2.7% (95%CI 1.6-4.5; I 2 =3%). The pooled rate of recurrence after the first dilation was 42.3% (95%CI 16.9-72.5; I 2 =59%), and the rate of repeat endoscopic balloon dilation was 23.9% (95%CI 14.1%-37.5%; I 2 =85%), while the pooled rate of repeat surgery was 25.3% (95%CI 11.8%-46.0%; I 2 =44%]., Conclusion: BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery., Competing Interests: Conflict of Interest: DGA: Consultant for Boston Scientific; all other authors declare no conflicts of interest., (Copyright: © 2024 Hellenic Society of Gastroenterology.)

Published
2024
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39. Temporal trends and risk factors of gastrointestinal bleeding in patients with left ventricular assist devices: a nationwide analysis 2008-2017.

Author

Vohra I, Mutneja H, Katiyar V, Mohan BP, and Adler D

Abstract

Background: Left ventricular assist devices (LVADs) are indicated for patients with end-stage heart failure and require systemic anticoagulation. Gastrointestinal (GI) bleeding is a major adverse event following LVAD implantation. There is paucity of data on healthcare resource utilization in patients with LVAD and the risk factors of associated bleeding, despite the increase in GI bleeding. We investigated the in-hospital outcomes of GI bleeding in patients with continuous-flow (CF) LVAD., Methods: This was a serial cross-sectional study of the Nationwide Inpatient Sample (NIS) in the CF-LVAD era from 2008-2017. All adults admitted to hospital with a primary diagnosis of GI bleeding were included. GI bleeding was diagnosed by ICD-9/ICD-10 codes. Patients with CF-LVAD (cases) and without CF-LVAD (controls) were compared using univariate and multivariate analyses., Results: A total of 3,107,471 patients were discharged with a primary diagnosis of GI bleeding during the study period. Of these, 6569 (0.21%) had CF-LVAD-related GI bleeding. Overall, bleeding angiodysplasia accounted for the majority (69%) of LVAD-related GI bleeding. There was no statistical difference in mortality, but the length of hospital stay increased by 2.53 days (95% confidence interval [CI] 1.78-2.98; P<0.001) and the mean hospital charge per stay increased by $25,980 (95%CI 21,267-29,874; P<0.001) in 2017 compared to 2008. The results were consistent after propensity score matching., Conclusion: Our study highlights that patients with LVAD admitted to the hospital for GI bleeding experience longer hospital stays and greater healthcare costs that warrant risk-based patient evaluation and careful implementation of management strategies., Competing Interests: Conflict of Interest: None, (Copyright: © Hellenic Society of Gastroenterology.)

Published
2023
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