GASTROENTEROLOGY AND GI SURGERY - NYU … the past year, we have advanced our research program, our...

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GASTROENTEROLOGY AND GI SURGERY2014 YEAR IN REVIEW

CONTENTS

1 Message from Leadership

2 Facts & Figures

4 New & Noteworthy

10 Microbiome

14 Clinical Care

15 Colon Cancer

18 Liver Disease

20 Esophageal Disease

22 Pancreatic Disease

24 Research

26 Publications

28 Locations

29 Leadership

Creative Direction: Ideas On Purpose, www.ideasonpurpose.com

Design: Craig Williams

Produced by: Office of Communications and Marketing, NYU Langone

Dear Colleagues and Friends, We are delighted to share with you this report on the achievements of the NYU Langone Medical Center Gastrointestinal (GI) Disease Service Line, reflecting the combined efforts of the Division of Gastroenterology and the Department of Surgery in addressing benign and malignant GI disease.

Over the past year, we have advanced our research program, our clinical mission, and our exemplary tradition of education, outreach, and service to our community and its underserved populations. We continue to work collaboratively to help forge a better future with more effective options in the screening, prevention, diagnosis, and treatment of esophageal, gastric, hepatic, pancreatic, intestinal, and colorectal diseases.

In research, we have built on a robust foundation in basic science and translational investigation and a clinical research initiative with more than 60 active clinical trials in GI and hepatobiliary cancer and other disease. One of our major areas of focus is the human microbiome and its role in numerous disease states—including obesity, inflammatory bowel disease, colorectal cancer, and pancreatic cancer— to reveal mechanisms and markers that can be targeted for intervention.

In the clinical arena, we deliver integrated, patient-centered, multidisciplinary care. Our evaluation of the latest scientific and technological advances leads us to the most optimal diagnostic and treatment options for our patients, including full-spectrum endoscopy, endoscopic cuff-assisted colonoscopy, and capsule colonoscopy for colon cancer screening; WATS3D brush biopsy for detection of Barrett’s esophagus; and 3D high-resolution manometry for the diagnosis of esophageal motility disorders.

When treatment is needed, we offer the most advanced interventions—from newly approved medical therapies to innovative, minimally invasive endoscopic and surgical technologies and techniques—and clinical trials that may provide even more promising options. Recent developments include a new interferon-free hepatitis C protocol, laparoscopic and robot-assisted surgery for GI cancers, hyperthermic therapy for colorectal cancer, a laparoscopic approach to the Whipple procedure for pancreatic cancer, advanced endoluminal treatments (POEM, ESD, etc.) and partial pancreatic resections. In addition to these ongoing advances, our faculty are contributing to the field through their leadership in professional societies, on editorial boards, and in collaborations with local, regional, and national community-based organizations.

With these developments, our care quality measures have been enhanced, including lower risk-adjusted mortality and length of stay than any of the New York institutions rated by the University HealthSystem Consortium (UHC®). We are proud that the multidisciplinary care provided by our gastroenterologists, hepatologists, oncologists, GI surgeons, and other specialists leads to optimal outcomes and experience for patients suffering from the most complex and debilitating GI and hepatobiliary conditions.

MESSAGE FROM LEADERSHIP

MARK B. POCHAPIN, MD

Sholtz/Leeds Professor of Gastroenterology

Professor of Medicine

Director of the Division of Gastroenterology

NYU Langone Medical Center

H. LEON PACHTER, MD

George David Stewart Professor of Surgery

Chair of the Department of Surgery


PAGE 1NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

FACTS & FIGURES*

Gastroenterology & GI Surgery

>50%

4NYU Langone was among

THE FIRST INSTITUTIONS in the United States to offer:

Full-spectrum endoscopy

3D, high-resolution esophageal manometry

Colon capsule endoscopy

Cuff-assisted colonoscopy

20,000 ENDOSCOPY

PROCEDURES ANNUALLY

of SURGICAL RESIDENTS

perform

SCIENCE RESEARCHCLINICAL or BASIC

53% 144GASTROENTEROLOGISTS& HEPATOLOGISTS

including

SALARIED & VOLUNTARY FACULTY

12 GASTROENTEROLOGY & HEPATOLOGY

PRACTICE LOCATIONS

OF GASTROENTEROLOGY FELLOWS over the last seven years are now in

or ACADEMIC PRACTICE ADVANCED FELLOWSHIPS

of Graduating Surgical Residents

GO INTO FELLOWSHIPS

93%

60+ active clinical trials are under way in

GASTROINTESTINAL DISEASE,

LIVER DISEASE, ANDLIVER TRANSPLANT

*Numbers represent FY14 (Sept 2013-Aug 2014) unless otherwise noted

NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014PAGE 2

Ranked #15 on “Best Hospitals” Honor Rolland nationally ranked in 13 specialties by U.S. News & World Report

Ranked #1 for Two Years in a Row in overall patient safety and quality, among leading academic medical centers across the nation that participated in the University HealthSystem Consortium Quality & Accountability Study

Magnet Designation for Third Consecutive Termfor Tisch Hospital and Rusk Rehabilitation, an honor achieved by only 2% of hospitals in the country. NYU Langone’s Hospital for Joint Diseases received its first Magnet recognition in 2012.


Ranked One of the Top 20 Medical Schoolsby U.S. News & World Report


NEW & NOTEWORTHY

Transformation through Growth and Innovation

RESEARCH NYU Langone Receives Significant Research Funding for Pancreatic Disease

Investigating biochemical mediators responsible for pancreatic tumor progression. George Miller, MD, associate professor of surgery and director of the S. Arthur Localio Laboratory, has received a National Institutes of Health (NIH) $1,250,000 R01 grant for a study of “Toll-like Receptor Regulation of Pancreatic Tumor Genesis.” Postulating that ligation of toll-like receptors within the inflammatory tumor stroma drives both stromal advancement and epithelial mutagenesis via novel signaling mechanisms, the research protocol is designed to reveal whether blockading toll-like receptors is a promising approach to experimental therapeutics in pancreatic cancer.

Necroptosis as a central mechanism governing pancreatic cancer cell demise? Funded by a $200,000 2014 Pancreatic Cancer Action Network-AACR Innovative Grant, Dr. Miller is also investigating whether necroptosis is a central mechanism governing pancreatic cancer cellular demise. The research is intended to advance the understanding of pancreatic cancer cell biology and related development of novel therapeutics.

Pioneering study of the oral microbiome and related pancreatic cancer risk. Dr. Miller is the co-investigator on a $90,000 National Cancer Institute R01 grant for a

“Prospective Study of Oral Microbiome in Pancreatic Cancer.” The research will investigate the latest genomic microbiome and transcriptome assays for assessing oral

APPOINTMENT Laparoscopic GI Surgeon Specialist Joins NYU Langone

NYU Langone named Paresh C. Shah, MD, chief of the Division of General Surgery and vice chair of quality and innovation in surgery. He specializes in laparoscopic Whipple surgery for pancreatic cancer, other GI resections, and therapeutic endoscopy techniques such as per-oral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD). Dr. Shah is recognized internationally as a leader in minimally invasive surgery and gastrointestinal disease. Dr. Shah serves on the board of governors of the Society of American Gastrointestinal and Endoscopic Surgeons and on the editorial review boards of Surgical Endoscopy, Journal of the American College of Surgeons, and Surgery of Obesity & Related Diseases.

and pancreas microbiota, and their possible role in pancreatic cancer.

Exploring the gut microbiome and pancreatic cancer. Dr. Miller is co-investigator of research funded by an $840,000 Lustgarten Foundation grant to study the role of the gut microbiome in the development of pancreatic carcinogenesis.


EDUCATION Potential New Funding for Research Training for GI Oncology

NYU Langone has received highly favorable scores on a recent grant application to fund “Research Training for Physician-Scientists in Gastrointestinal Oncology” from the NIH.

Gastrointestinal Oncology Research Fellowship Program among First in the Country

The new Bernard and Irene Schwartz Gastrointestinal Oncology Fellowship Program, launched in 2014, will be among the first in the country dedicated to training physician-scientists in gastrointestinal cancer research. Focus areas will include the pancreatic cancer tumor microenvironment, the molecular basis of cancer development, bacteria and viruses that influence cancer development, and gastrointestinal inflammation that can lead to cancer.

EXPANSION Gift Propels Growth of Cancer Center

Benjamin G. Neel, MD, PhD, assumed the directorship of the Laura and Isaac Perlmutter Cancer Center (formerly NYU Cancer Institute) in January 2014. A world-renowned cancer biologist, Dr. Neel previously directed the Toronto-based Ontario Cancer Institute, Canada’s largest cancer research center. The Perlmutter Cancer Center is poised for growth following a gift in excess of $50 million from the Laura and Isaac Perlmutter Foundation to advance cancer research and treatment at NYU Langone.

OUTREACH Providing Evidence for the Adverse Effects of Antibiotics

Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues by Martin Blaser, MD, was published in 2014 and was favorably reviewed by The New York Times. The book provides evidence for the adverse effects of antibiotics, and tells what can be done to avoid catastrophic health problems in the future. Dr. Blaser is the Muriel G. and George W. Singer Professor of Translational Medicine and director of the Human Microbiome Program.

Gastroenterology Fellowship Program Produces IBD iBook

With support from an American Gastroenterological Association education grant, Sophie M. Balzora, MD, assistant professor of medicine; Lisa Malter, MD, assistant professor of medicine; and Martin Wolff, MD, senior gastroenterology fellow, developed the new iBook, NYU Langone Gastroenterology Fellowship Training Program Pocket Guide: Key Concepts in Managing Patients with Inflammatory Bowel Disease (IBD). The new resource is designed to be used on iPads or smart-phones in the management of Crohn’s disease and ulcerative colitis. The changing landscape of therapeutics makes treating patients with IBD complex, so it’s increasingly important for gastroenterology fellows to understand the complete care of IBD patients. The “pocket guide” was created to supplement gastroenterology fellowship education by providing a comprehensive, case-based, quick reference to managing IBD. The iBook was created in collaboration with the NYU School of Medicine Institute for Innovations in Medical Education. The iBook can be downloaded at iTunes, https://itunes.apple.com/us/book/key-concepts-in-managing-patients/id915394601?mt=11.


NEW & NOTEWORTHY

questions from participants about the importance of colon cancer screening recommendations and options.

As a frequent contributor to Fox News, Today, CNN, and ABC News, Roshini Rajapaksa, MD, associate professor of medicine, is also spreading the word about the importance of colon cancer screening. She specializes in women’s health issues and has published several studies related to colon cancer screening.

OUTREACH Engaging with the Media to Promote Colon Cancer Screening

According to the American Cancer Society, colon cancer incidence has decreased by 30 percent over the last decade in large part due to an increase in colon cancer screening. However far too many people still forgo screening. NYU Langone is committed to helping everyone understand how screening saves lives.

Sandra Turns 50 is a short animation developed by NYU Langone and funded by a New York Society for Gastrointestinal Endoscopy Florence Lefcourt Award designed to dispel misperceptions about colon cancer and encourage screening. Using engaging graphics and easy-to-follow narration, the video is the newest tool in NYU Langone’s robust community outreach program, and can be viewed on YouTube.

In another novel approach to community education and outreach, Jonathan LaPook, MD, the Mebane Professor of Gastroenterology and CBS News chief medical correspondent, hosted a Google+ Hangout with Mark B. Pochapin, MD, the Sholtz/Leeds Professor of Gastroenterology and director of the Division of Gastroenterology, and Gina Mileo, RN. The trio took

PARAESOPHAGEAL HERNIAS Repairing 100 Percent of Paraesophageal and Hiatal Hernias Laparoscopically

All repair of paraesophageal and hiatal hernias is performed laparoscopically at NYU Langone, helping to reduce length of stay and improve patient experience. Paraesophageal hernias are on the rise, and NYU Langone is also a high-volume center, performing close to 50 repairs a year.


Awards and Recognitions

Dafna Bar-Sagi, PhD, senior vice president, vice dean for science, and chief scientific officer, received a 2014 Pancreatic Cancer Action Network - AACR Innovative Grant to study whether anatomical location in the pancreas can dictate the course of tumor development. In 70 to 80 percent of cases, pancreatic ductal adenocarcinoma develops in the pancreas head and uncinate process regions, leading to speculation about the importance of location in tumor development.

Russell S. Berman, MD, associate professor of surgery, won the 2014 Alpha Omega Alpha Alumni Award and was appointed chairman of the Society of Surgical Oncology SCORE Committee. He is also an associate examiner for the American Board of Surgery, associate editor of the Journal of the National Cancer Institute, and a member of the National Cancer Institute’s PDQ® Adult Treatment Editorial Board.

Mitchell A. Bernstein, MD, associate professor and director, colon and rectal surgery, and Harvey G. Moore, MD, assistant professor of surgery, are collaborating with principal investigator Cynthia G. Leichman, MD, to examine the “Gene Methylation Profile of Rectal Cancer and its Predictive Value for Response to Neoadjuvant Chemoradiation Therapy.”

Audio-Digest Foundation’s General Surgery Board Review will feature a course on Anal Cancer by Mitchell A. Bernstein, MD.

Martin J. Blaser, MD, the Muriel G. and George W. Singer Professor of Translational Medicine and director of the Human Microbiome Program, received the Pancreatic Cancer Action Network-AACR Innovative Award.

Lea Ann Chen, MD, instructor in medicine, was elected vice chair of the New York Crohn’s and Colitis Organization and serves on the organization’s executive council.

Ilseung Cho, MD, assistant professor of medicine, received a 2014 Clinical Scientist Development Award from the Doris Duke Charitable Foundation. The award will support Dr. Cho’s research into the role of the human microbiome in the development of colon cancer. He hypothesizes that the human microbiome may cause hypermethylation of specific DNA repair genes, impairing the body’s ability to repair damaged cells and leading to precancerous and cancerous lesions. Dr. Cho’s previous research revealed possible links between the human microbiome and obesity, and was published in Nature and Cell.

Donnele Daley, MD, teaching assistant in the Department of Surgery, received the Schwartz GI Fellowship for her research work under the mentorship of George Miller , MD.


NEW & NOTEWORTHY

George A. Fielding, MD, the J. Ira and Nicki Harris Family Professor of Surgery and Bariatric Medicine, was named one of the 30 most influential members of the American Society of Metabolic and Bariatric Surgery over the last 30 years.

Fritz François, MD, associate professor of medicine, was named recipient of the American College of Gastroenterology’s Minority Digestive Health Care Award. The judges cited his active involvement in clinical practice/clinical research and efforts to improve the digestive health of a minority group or underserved population.

Adam J. Goodman, MD, assistant professor of medicine and director of endoscopy at Bellevue Hospital Center, has been named vice president of the New York Society for Gastrointestinal Endoscopy. He will become the society’s president in 2015.

Seth A. Gross, MD, associate professor of medicine and gastroenterology section chief, was appointed an associate

editor of the American Society for Gastrointestinal Endoscopy (ASGE) journal Gastrointestinal Endoscopy. He also serves on the ASGE practice management committee, and on the American College of Gastroenterology (ACG) training committee, and educational affairs committee. He is editor of ACG Universe and is the ACG’s American Board of Internal Medicine liaison.

Norman B. Javitt, MD, PhD, professor of medicine and pediatrics, won the American Physiological Society’s History of Physiology Group 2014 Recognition Award for his presentation, “The History of Hepatic Bile Formation: Investigator’s Dilemma; Patient’s Problems,” presented at Experimental Biology 2014.

Seymour Katz, MD, clinical professor of medicine, was named to the New York Crohn’s and Colitis Organization executive council.


Harvey G. Moore, MD, assistant professor of surgery, received the “Works in Progress Award” from the American Society of Colon and Rectal Surgeons Research Foundation for his paper, “Novel Inhibitors of WNT/β-Catenin Responsive Transcription Augment Response of HCT116 CRC Cells to Radiation In Vitro and In Vivo.” He was also named a total mesorectal excision-credentialed surgeon by the Alliance for Clinical Trials in Oncology and serves on the Fundamentals of Rectal Cancer Surgery Committee of the American Society of Colon and Rectal Surgeons.

H. Leon Pachter, MD, the George David Stewart Professor of Surgery and chair of the Department of Surgery, serves on the editorial boards of Annals of Surgery and The Journal of Trauma and Critical Care.

Mark B. Pochapin, MD, the Sholtz/Leeds Professor of Gastroenterology and director of the Division of Gastroenterology, has been reappointed to the steering committee of the National Colorectal Cancer Roundtable.

He also serves on the board of trustees of the American College of Gastroenterology (ACG) and as director and treasurer of the ACG and American Society for Gastrointestinal Endoscopy’s collaborative GIQuIC quality initiative.

Paresh C. Shah, MD, professor of surgery and vice chair of quality and innovation in surgery, was the recipient of the Excellence in Medical Leadership Award from the Society of American Gastrointestinal and Endoscopic Surgeons.

Alejandro Torres-Hernandez, MD, postdoctoral fellow under the mentorship of Dr. George Miller, was awarded the “Emerging Liver Scholar Award” from the American Association for the Study of Liver Diseases.

Lewis W. Teperman, MD, associate professor of surgery, was named Physician of the Year in 2014 by the American Liver Association Greater New York Division.


The Human Microbiome

NYU Langone researchers are dedicated to fully understanding the gut, the immune system’s largest sensory organ; gut microbiome; and its role in gastrointestinal disease, prevention, and treatment.

THE HUMAN MICROBIOME


One Cause of Obesity May Be Microbiome Alterations

Bacteria living in the human gastrointestinal tract outnumber human cells by a factor of 10—and the aggregate genetic information contained within those bacteria is several magnitudes greater than that found in the host human genome. This emerging field of research is revealing that perturbing our resident microbial communities at critical time points can have damaging—and lasting—consequences. Martin J. Blaser, MD, the Muriel G. and George W. Singer Professor of Translational Medicine and director of the Human Microbiome Program, is leading a research team to shed new light on how antibiotics can profoundly reshape the microbial communities that live within us and contribute to chronic conditions.

According to this research, conducted by Ilseung Cho, MD, assistant professor of medicine, these alterations in the gut microbiome may be driving certain cases of obesity. Sub-therapeutic antibiotics are regularly given to animals in the agricultural industry to promote growth by allowing feed to be more thoroughly digested and absorbed. Those antibiotics subsequently enter the food chain and may promote similar effects in humans. There may also be a link between obesity and the over-prescription of therapeutic antibiotics in humans for various childhood infections. “We’ve developed a murine model to demonstrate that exposure to low-dose antibiotics can permanently change the gut microbiome, leading to weight gain and altered body composition,” says Dr. Cho. NYU Langone is dedicated to fully understanding the gut, the immune system’s largest sensory organ; gut microbiome; and its role in gastrointestinal disease, prevention, and treatment.

Investigating Gut Microbiome Changes in Pediatric Patients with C. difficile Colitis

According to the to the Centers for Disease Control and Prevention, about 14,000 Americans die each year from Clostridium difficile, or C. diff, infection. Antibiotics often can be ineffective in treating this infection, and fecal microbial transplant has been demonstrated in most studies to date to be more than 90 percent effective in treating C. diff cases in patients who do not respond to conventional antibiotic therapies.

In a collaborative effort with the Johns Hopkins School of Medicine, NYU Langone’s Lea Ann Chen, MD, instructor of medicine, is investigating the gut microbiome of pediatric patients ages 6 to 17 with C. diff colitis who have failed conventional therapies, observing changes following fecal transplant. Each patient serves as his or her own control; researchers collect stool samples before and after fecal transplant. As a second control, researchers collect stool samples from fecal transplant donors (usually an adult family member).

As she explains, “We’re evaluating the differences between the gut microbiome of healthy donors and children who have recurrent C. diff infections requiring fecal transplant, to better understand why the transplants work and why certain patients, such as those with inflammatory bowel disease, are at increased risk for recurrent C. diff infections.”

Cultivating Insights from the Microbiome




Linking the Microbiome, Pancreatic Inflammation, and Cancer

George Miller, MD, associate professor of surgery and director of the S. Arthur Localio Laboratory, is studying inflammatory conditions, such as pancreatitis, that represent well-known risk factors for pancreatic cancer. In the May/June 2014 issue of Cancer Journal, our researchers reported that a substantial amount of preclinical and clinical evidence suggests that bacteria are likely to influence this process by activating immune receptors and perpetuating cancer-associated inflammation. Recent investigations of the human microbiome have highlighted how perturbations of commensal bacterial populations can promote inflammation and disease processes, including cancer. Revealing the interplay between inflammation and the microbiome in the context of pancreatic cancer will provide novel targets for prevention and treatment.

EVIDENCE SHOWS GUT VIRUSES ALSO PLAY ROLE IN INTESTINAL ECOSYSTEM

NYU Langone microbiologists have what may be the first strong evidence that the natural presence of viruses in the gut—or the “virome”—plays a health maintenance and infection-fighting role similar to that of intestinal bacteria. In a series of experiments reported November 19, 2014 in Nature Online, researchers found that infection with the common murine norovirus helped mice repair intestinal tissue damaged by inflammation and restore the gut’s immune defenses after its microbiome had been wiped out by antibiotic therapy. They also report that murine norovirus bolstered the immune system. “Our research offers compelling data about the mutually supportive relationship between viruses and bacteria in the mouse gut, and lays the groundwork for further research on precisely how the virome supports the immune system,” concludes Ken Cadwell, PhD, assistant professor of microbiology and principal investigator of the Cadwell Laboratory.

Bacteria living in the human gastrointestinal tract

outnumber human cells by a factor of 10


Radiologic imaging plays an essential role in supporting all of the medical and surgical specialties at NYU Langone and throughout the community. With quality and safety at its core, our model of patient-centered care includes a highly focused program of process improvement along with the ongoing investment in the technology and resources necessary to sustain excellence in patient care, research, and education.


CLINICAL CARE

Clinical Care

Our clinicians are leading the way in the use of novel approaches to the prevention, diagnosis, and treatment of gastrointestinal conditions.


Colonoscopy remains a gold standard in colon cancer screening, and NYU Langone gastroenterologists are among the first in the nation to offer the latest colonoscopy technologies and techniques. “The focus remains always on quality in endoscopy,” says Mark B. Pochapin, MD, the Sholtz/Leeds Professor of Gastroenterology and director of the Division of Gastroenterology, “along with a positive patient experience for this life-saving screening.”

• Full-spectrum endoscopy technology. While traditional colonoscopy provides a 170-degree view of the colon, the new full-spectrum endoscopy technology allows for a 330-degree visual field. This new, expanded optical view offers promise in enhancing the endoscopist’s ability to spot potentially hidden polyps and thus increase polyp/ adenoma detection rates.

• Endoscopic cuff-assisted colonoscopy. With endoscopic cuff-assisted colonoscopy, a soft, flexible projection is attached to the end of the colonoscope. During withdrawal, the tiny flexible fingers of the cuff help grip the colon wall to mechanically flatten folds and enhance visualization of potentially hidden polyps.

• New FDA-approved colon capsule endoscopy. NYU Langone gastroenterologists offer the new, Food and Drug Administration (FDA)-approved colon capsule endoscopy for the small subgroup of patients who undergo an incomplete colonoscopy.

Reducing a Preventable Burden

COLON CANCER

Among the First to Offer and Evaluate New Colonoscopy Technologies

The camera pill is utilized to capture images from the area of the colon that could not be viewed during the original colonoscopy procedure.

• A non-oral, same-day prep regimen. NYU Langone offers select patients the option of colonic irrigation—a bowel prep technique for patients whose co-morbidities contraindicate the use of the oral prep, who cannot tolerate the oral prep regimen, or for whom the oral prep is insufficient to allow for effective visualization of the colon. This technique offers a non-oral, same-day prep regimen for patients in need of this option.

• Balloon-assisted colonoscopy. Balloon-assisted colonoscopy is being evaluated for effectiveness by NYU Langone gastroenterologists. With this technique, the colonoscopy is fitted with an integrated, reusable balloon. Upon reaching the cecum, the balloon is inflated. As the colonoscope is withdrawn, the balloon acts to smooth out folds on the colon wall. In a recent multicenter tandem study presented at national and international conferences, Seth A. Gross, MD, associate professor of medicine and gastroenterology section chief; Mark B. Pochapin, MD, the Sholtz/Leeds Professor of Gastroenterology and director of the Division of Gastroenterology; and colleagues compared balloon-assisted with traditional colonoscopy, finding improved polyp and adenoma detection rates with the balloon-assisted technology.


CLINICAL CARE

gelatinous or liquid than solid. This process is commonly called carcinomatosis or pseudomyxoma (if more gelatinous). With colorectal and appendiceal cancers, and even appendiceal tumors that are not clearly cancer, this type of spread can be treated by debulking the tumor strips or masses through cytoreductive surgery followed by direct installation of heated chemotherapy (hyperthermic intraperitoneal chemotherapy, or HIPEC) into the abdominal cavity during surgery. This approach may also be an option for other types of cancers. By delivering chemotherapy directly, HIPEC enables drug-to-tumor contact, increases efficacy, allows for a much higher chemotherapy concentration than would be possible with intravenous therapy, and minimizes side effects, notes Russell S. Berman, MD, associate professor of surgery.

Promoting Colon Cancer Screening in the African American Community

Focusing on barriers to care in the African American community, particularly in relation to increasing colon cancer screening, Joseph Ravenell, MD, assistant professor of medicine, has identified intrinsic and extrinsic barriers to health and primary healthcare use among African Americans in a low-income, urban area. Expanding on community-based research models that Dr. Ravenell and Olugbenga G. Ogedegbe, MD, professor of population health and medicine and director of NYU Langone’s Center for Healthful Behavior Change, developed around hypertension, Dr. Ravenell is leading National Institutes of Health (NIH)-funded research utilizing a faith-based approach to colon cancer screening in the New York City African American community. As part of this cluster-randomized controlled trial, Dr. Ravenell’s team has provided educational interventions about colorectal cancer in 89 churches and mosques, reaching nearly 3,380 black men age 50 and older and enrolling 451 participants in the study. Additionally, they have trained over 100 lay health workers at these churches to deliver colorectal cancer screening information to their congregations. The researchers hope this program will serve as a new model for evidence-based education/outreach and linking faith-based settings to the healthcare system, thereby increasing colon cancer screening in African American men nationwide.

Minimally-invasive Approaches Preserve Function and Shorten Recovery

NYU Langone is at the forefront of minimally invasive surgery (including the TAMIS transanal minimally invasive technique), with the vast majority of colorectal surgeries performed laparoscopically compared to approximately 20 percent nationally. NYU Langone was the first medical center in New York City to perform colorectal surgery robotically over a decade ago. Experts at the Robotic Surgery Center are international leaders in performing a wide range of minimally invasive procedures with robotic assistance. “The robot can be helpful particularly with colorectal cancer situated in the lower rectum,” explains Elliot Newman, MD, professor of surgery, “where the robot’s precision and maneuverability help preserve normal bowel function and can avoid the need for permanent colostomy.” Surgeons perform more than 1,600 robot-assisted surgeries each year in dedicated operating rooms using one of five state-of-the-art surgical systems that include advanced infrared imaging, dual consoles, and the latest da Vinci® Si and Xi surgical systems. NYU Langone gastroenterologists also use minimally invasive colonoscopic techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) to remove large polyps and early-stage cancer of the rectum without a major operation. “Within the context of personalized patient care,” says Dr. Newman, “NYU Langone offers a full range of minimally invasive surgical and endoscopic procedures for colorectal cancer when they are appropriate and may result in faster recovery and reduced length of stay.”

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Plus Cytoreductive Surgery Applied to Colorectal Tumors

NYU Langone has an active program to treat peritoneal surface malignancy. Under certain circumstances, gastrointestinal tract malignancies and other types of tumors can spread along the linings of the intra-abdominal organs and the inner lining of the abdominal wall itself. Sometimes, this is more


At the weekly Multidisciplinary Gastrointestinal and Hepatobiliary Cancer Patient Case Conference, NYU Langone physicians present complex patient cases for discussion. Together, gastroenterologists, hepatologists, surgeons, medical oncologists, radiation oncologists, interventional radiologists, transplant specialists, and others confer to develop a team recommendation for these patients’ treatment plans. Importantly, appropriate clinical trials and clinical support services are also discussed to optimize care.

MULTIDISCIPLINARY PATIENT CASE CONFERENCE FOR COMPLEX GI CANCERS

80%-90% of colorectal surgeries at

NYU Langone are performed robotically and

laparoscopically, compared to

approximately 20 percent nationally


recently approved FDA medications.” Although hepatitis C can be cured, prudent surveillance for hepatocellular carcinoma (HCC) is mandatory. HCC remains the primary indication for liver transplantation at our institution.

Serving Asian American Communities at Risk

With 1.1 million Asian American residents, New York City is home to the largest population of Asian Americans in the United States. Unfortunately, liver disease is a leading cause of death in this population, and Asian Americans have the highest incidence of liver cancer of any racial/ethnic group. NYU Langone’s Asian Liver Disease Program is focused specifically on the needs, diagnosis, and treatment of Asian Americans,

providing multidisciplinary medical, surgical, and support services. James Park, MD, assistant professor of medicine and director of the Asian Liver Disease Program, explains, “By focusing on this population, we hope to reduce the morbidity and mortality associated with liver cancer and other liver disease in Asian Americans, and develop new approaches to liver disease screening, diagnosis, treatment, and transplantation.”

A New Hepatitis C Treatment Offers Nearly 100 Percent Cure

An estimated 3.2 million people in the United States have chronic hepatitis C infection, and approximately 75 percent of them are baby boomers. With such a large number affected, finding better, less toxic medical therapies is crucial. A study conducted by Samuel Sigal, MD, associate professor of medicine and clinical director of hepatology, has shown promising results for a new hepatitis C treatment recently approved for use by the Food and Drug Administration (FDA). The international, phase 3 study reported in The New England Journal of Medicine demonstrated the efficacy of an interferon-free, all-oral antiviral therapy for previously untreated patients with HCV genotype 1 infection and without cirrhosis. “We now have a treatment shown to deliver close to 100 percent cure with minimal side effects, and that’s a hepatitis C game changer,” says Dr. Sigal.

NYU Langone’s liver disease program is a model of advanced, integrated care provided by leading specialists, including hepatologists, transplant hepatologists, interventional radiologists, GI surgeons, surgical oncologists, transplant surgeons, and medical oncologists. They employ a full range of modalities to diagnose and treat liver disease, including minimally invasive robotic and laparoscopic surgery, ablation for lesions not amenable to direct resection, and directed radiation therapy to deliver microspheres directly into a tumor’s arterial supply. A robust research program offers patients the opportunity to participate in the latest clinical trials as NYU Langone scientists work to develop new treatments and, eventually, prevent liver disease. As part of NYU Langone’s liver disease program, The Mary Lea Johnson Richards Organ Transplantation Center provides liver transplant, non-transplant hepatobiliary surgery, and liver cancer resection. Lewis Teperman, MD, associate professor of surgery and director of the Mary Lea Richards Organ Transplantation Center says,

“The liver transplant program has been at the forefront of treating hepatitis C pre- and post-transplantation. Our most recent study has shown a better than 90 percent success rate for post-transplant hepatitis C using the

LIVER DISEASE

CLINICAL CARE

New Hope for Those at Risk

—

“We hope to reduce the morbidity and mortality associated with liver cancer and other liver disease in Asian Americans.”

—

Game Changer:

New Hepatitis C Treatment Delivers Close to 100 Percent Cure with Minimal Side Effects


Although the understanding of cellular and biochemical factors underlying liver fibrosis is still rudimentary, an NYU Langone research study being funded by a 2014 K08 award and an R03 award from the National Institute of Diabetes and Digestive and Kidney Diseases promises to lead to a new area of experimental therapeutics. George Miller, MD, associate professor of surgery and director of the S. Arthur Localio Laboratory, is studying the role of dendritic cells in the pathogenesis of liver fibrosis. Dr. Miller’s preliminary data show that in hepatic fibrosis, dendritic cells are remarkably effective at engaging both innate and adaptive immunity. Moreover, dendritic cells are entirely responsible for

the elevated hepatic cytokine milieu in the fibrotic liver. The increased inflammation and enhanced stimulation of T cells and NK cells by dendritic cells in liver fibrosis is contingent on their elevated production of TNF-α. Researchers hope to determine whether dendritic cells convert from inert inducers of tolerance to potent immune stimulators in liver fibrosis, determine the contributory role of dendritic cells in the pathogenesis of fibrosis and their direct role in hepatic stellate cell activation, and determine whether blockade of the immunogenic function of dendritic cells can mitigate the fibrogenic response to liver injury.

Targeting Dendritic Cells in Liver Fibrosis Pathogenesis


CLINICAL CARE

New Detection Tools and Advanced Therapies

Wide-area transepithelial sampling (WATS3D) brush biopsy with computer-assisted tissue analysis increases detection of Barrett’s esophagus, according to new research presented at the May 2014 international Digestive Disease Week conference and led by Seth A. Gross, MD, associate professor of medicine. Traditional forceps biopsy alone can leave tissue not sampled that could harbor advanced dysplasia or neoplasia. By contrast, in a study of 2,559 patients who underwent upper endoscopy, the addition of WATS3D identified an additional 258 instances of Barrett’s esophagus—increasing detection by 68.4 percent. WATS3D also detected an additional 10 cases of dysplasia and one cancer missed by forceps biopsy. Adjunctive use of WATS3D increased dysplasia/neoplasia detection by 64.7 percent. “In light of recent changes to Barrett’s esophagus management guidelines,” says Dr. Gross,

“improved dysplasia detection is critical—and the

WATS3D approach offers promise in this area of medicine.” When further treatment is needed, NYU Langone employs a range of endoscopic interventions, including endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), radiofrequency ablation, and cryotherapy.

NYU Langone’s Center for Esophageal Disease brings together specialists highly experienced in the prevention, diagnosis, and treatment of the full range of esophageal disease, including chronic gastroesophageal reflux disease (GERD), hiatal hernia, swallowing disorders, Barrett’s esophagus, and esophageal cancers. The center offers the newest diagnostic tests, including high-resolution manometry, pH and impedance testing, endomicroscopy, endoscopic and surgical ultrasound, and upper endoscopy as well as advanced endoscopic interventions.

ESOPHAGEAL DISEASE

A Better Biopsy for Detecting Barrett’s Esophagus


New Manometry Technologies Offer Promise in Esophageal Motility Disorders

NYU Langone is studying the latest technologies in the diagnosis and treatment of reflux disease, achalasia, and other swallowing disorders. One example of this research initiative includes evaluation of new three-dimensional (3D) high-resolution manometry for esophageal disease. “The 3D component has been found to be useful in anorectal manometry testing, and we are now investigating the application and potential benefits of this technology for esophageal disease, including achalasia and upper esophageal sphincter dysfunction,” says Abraham Khan, MD, assistant professor of medicine. “We’re offering the new 3D technology in addition to the high-resolution component of esophageal manometry, which allows for simultaneous testing of pressures from the pharynx to stomach, thus ensuring a complete profile and accurate diagnosis of any potential motility disorder.”

Minimally Invasive Interventions for GERD and Achalasia

NYU Langone is one of the first medical centers in New York State to offer LINX for the treatment of GERD resulting from a weak lower esophageal sphincter (LES). LINX is a small flexible band of interlinked titanium beads with magnetic cores. The magnetic attraction between beads helps the LES resist opening to gastric pressures, preventing reflux from the stomach into the

esophagus. Treatments for achalasia include pneumatic dilation laparoscopic Heller myotomy as per-oral endoscopic myotomy (POEM).

Lymph Node Ratio Affects Prognosis in Gastroesophageal Cancer

Depth of invasion and the presence or absence of lymph node metastasis are the most important prognostic factors in gastroesophageal cancer. But according to research being conducted by NYU Langone, presented during the American College of Surgeons Clinical Congress in Washington, DC, in October 2013, the ratio of the

number of nodes harboring metastatic cancer to the total number of lymph nodes examined may affect survival after esophagogastric resection. While classification of lymph node status in patients with gastric cancer remains controversial, researchers are looking to see if a higher lymph node ratio correlates with adverse pathologic features and is a negative prognostic factor in patients undergoing radical resection for gastroesophageal cancer.

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“Researchers are looking to see if a higher lymph-node ratio correlates with adverse pathologic features.”

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Fighting a Difficult Cancer On Every Front

CLINICAL CARE

Experienced Team Improves Outcomes for Patients with Complex Pancreatic Disease

According to the National Cancer Institute, approximately 1.5 percent of men and women will be diagnosed with pancreatic cancer at some point during their lifetime, based on 2009-2011 data. NYU Langone is among the top 10 performers in the nation in General Surgery in terms of mortality, according to the University HealthSystem Consortium.

NYU Langone surgeons are experts in performing Whipple surgery, or pancreaticoduodenectomy—a complex operation involving removal of the head of the pancreas and portions of the duodenum, gallbladder, bile duct and stomach—that has dramatically improved outcomes for eligible patients. Pancreatic resection and Whipple provide important options for eligible patients and the opportunity for long-term survival. Regardless of stage, we offer a full spectrum of options including surgery, chemotherapy, radiotherapy, biologic therapy, and clinical trials at the Laura and Isaac Perlmutter Cancer Center at NYU Langone.

For patients eligible for Whipple surgery, a subset of cases may warrant a laparoscopic approach. “Most patients leave the hospital in four to six days following laparoscopic Whipple surgery compared with eight to 10 days following conventional Whipple surgery,” says Paresh C. Shah, MD, professor and chief of the Division of General Surgery, who specializes in the procedure and is considered an international leader in minimally invasive surgery for pancreatic cysts and tumors. Research at NYU Langone has shown that Whipple surgery can also improve outcomes for octogenarian patients with pancreatic adenocarcinoma. While some studies have found acceptable morbidity and mortality in patients over age 70, there is little data on outcomes of Whipple surgery for patients over age 80. Marcovalerio Melis, MD, associate professor of surgery, studied

short-term outcomes and long-term survival in patients aged 80 or older, and demonstrated that pancreatic resection for pancreatic adenocarcinoma or other malignancy can be performed safely and with acceptable complication rates in well-selected octogenarians. “Multidisciplinary treatment planning and careful selection for surgery is critical,” said Dr. Melis. “But the opportunity for cure should not be denied to people past 80 with pancreatic adenocarcinoma based solely on age.

PANCREATIC DISEASE

Pancreaticoduodenectomy outcomes of patients

aged 80 and oldershow that the procedure can be performed

safely in this group

Stalling the Growth of Previously Untreatable K-Ras Cancers

NYU Langone researchers have found a biological weakness in the workings of the most commonly mutated gene involved in human cancers, mutant K-Ras. The gene has long been suspected of being the force behind more than a third of all cancers, including colon, lung, and a majority of pancreatic cancers. Ras cancers are unusually aggressive and have resisted every previous attempt to stall their growth. Reporting online February 10, 2014 in Cancer Cell, researchers in the laboratory of Dafna Bar-Sagi, PhD, senior vice president, vice dean for science, and chief scientific officer, led by Elda Grabocka, PhD, post-doctoral fellow, found that K-Ras tumor growth was highly dependent on the cells’ constant need to check and mend their DNA. This opens the door to development of chemotherapies designed to thwart K-Ras.


Experts are using

endoscopic ultrasound combined with

endomicroscopyto study and better characterize pancreatic

cysts and their potential to progress malignancy

Improving Pancreatic Cyst Understanding and Management

The best approach to the monitoring and treatment of pancreatic cysts continues to be an area of study and discussion. To collect important data in this area of care, NYU Langone gastroenterologists, surgeons, radiologists, and other specialists have developed a patient registry from among the approximately 900 pancreatic cysts detected at the Medical Center each year. In addition, they have developed a Medical Center-specific clinical algorithm to better risk-stratify patients who have pancreatic cysts. Over the next decade, they will be studying data gleaned from the patient registry and clinical algorithm with the goal of contributing to the knowledge base around pancreatic cysts, factors that may predict malignancy, and effective monitoring and treatment options. This multidisciplinary team is also employing innovative new approaches and technologies to optimize outcomes for patients with pancreatic cysts. For example, Seth A.

Gross, MD, associate professor of medicine and gastroenterology section chief, is using endoscopic ultrasound combined with endomicroscopy to study and better characterize pancreatic cysts and their potential to progress to malignancy.


Research

We continue to build upon our robust foundation in basic science and translational investigation.

RESEARCH


Select Active Research Grants

National Institutes of Health / R01 CA168611 04/01/13–03/31/17George Miller, MD (Principal Investigator)

“Toll-like Receptor Regulation of Pancreatic Tumorigenesis”

National Institutes of Health / R03 DK098303 02/15/13–02/14/15George Miller, MD (Principal Investigator)

“Effect of dendritic cell lipid content on hepatic inflammation and NASH pathogenesis”

National Institutes of Health / K08 DK085278 01/01/10–12/31/14George Miller, MD (Principal Investigator)

“Role of dendritic cells in the pathogenesis of liver fibrosis”

National Institutes of Health / K08 DK085278 07/01/15–12/31/15George Miller, MD (Principal Investigator)

“Role of dendritic cells in the pathogenesis of liver fibrosis”

DoD - Peer Reviewed Medical Research Program (PRMRP) 09/01/12–08/31/15George Miller, MD (Principal Investigator)

“Divergent Effects of Dendritic Cells on Pancreatitis”

National Institutes of Health / R24 OD18340 03/01/14–02/28/16 David Levy (Principal Investigator)

“Restoring Biospecimen Research Resources Lost Due to Superstorm Sandy” National Institutes of Health / R01 CA164964 09/01/14–06/30/18Jiyoung Ahn, PhD (Principal Investigator)

“Prospective Study of Oral Microbiome with Pancreatic Cancer”

Lustgarten Foundation Grant 01/01/13–12/31/16George Miller, MD (Principal Investigator)

“Role of the intestinal microbiome in promoting pancreatic carcinogenesis”

Pancreatic Cancer Action Network- AACR Innovative Grant 07/01/14–06/30/16George Miller, MD (Principal Investigator)

“Regulation of Pancreatic Tumorigenesis by Necroptosis”

Hirschl Weill-Caulier Research Award 01/01/11–12/31/15George Miller, MD (Principal Investigator)

“Dendritic cells link chronic pancreatitis to pancreatic carcinoma”

American Liver Foundation Postdoctoral Fellowship Award 07/01/14–06/30/15Lena Tomkoetter, MD (Principal Investigator)

“Role of Dectin-1 in liver fibrosis”

German Research Foundation (Federal Career Development Award) 09/01/14–08/31/17Lena Tomkoetter, MD (Principal Investigator)

“The role of γδ T cells in pancreatic tumorigenesis”

Ralph S. French Charitable Foundation 05/01/14–04/31/15George Miller, MD (Principal Investigator)

“Purchase of Mouse Ultrasound Machine for GI Cancer Research”

Schwartz Research Fellowship in GI Oncology Donnele Daly, MD (Principal Investigator)

“The necroptosis in pancreatic tumorigenesis”

Doris Duke Charitable Foundation07/01/14 -6/30/17Ilseung Cho, MD (Principal Investigator)

“Hypermethylation as a Microbiome-Mediated Epigenetic Phenomenon in CIMP(+) Colorectal Cancers”


Abramson SB, Jacob D, Rosenfeld M, Buckvar-Keltz L, Harnik V, Francois F, Rivera R, Hopkins MA, Triola M, Grossman RI. A 3-year M.D.—accelerating careers, diminishing debt. N Engl J Med. 2013;369(12):1085-1087.

Alloway RR, Eckhoff DE, Washburn WK, Teperman LW. Conversion from twice daily tacrolimus capsules to once daily extended-release tacrolimus (LCP-Tacro): phase 2 trial of stable liver transplant recipients. Liver Transpl. 2014;20(5):564-575.

Asrani SK, Wiesner RH, Trotter JF, Klintmalm G, Katz E, Maller E, Roberts J, Kneteman N, Teperman L, Fung JJ, Millis JM. De novo sirolimus and reduced-dose tacrolimus versus standard-dose tacrolimus after liver transplantation: the 2000-2003 phase II prospective randomized trial. Am J Transplant. 2014;14(2):356-366.

Bernstein MA, Purdy CH, Becker A, Magar R. Three-year cost-effectiveness model for non-animal stabilized hyaluronic acid and dextranomer copolymer compared with sacral nerve stimulation after conservative therapy for the management of fecal incontinence. Clin Ther. 2014;36(6):890-905.e3.

Charlton MR, Gane EJ, Manns MP, Brown RS, Curry MP, Kwo PY, Fontana RJ, Gilroy R, Teperman LW, Muir AJ, McHutchison JG, Symonds WT, Denning JM, McNair L, Arterburn S, Terrault N, Samuel D, Forns X. Sofosbuvir and ribavirin for the treatment of established recurrent hepatitis C infection after liver transplantation: preliminary results of a prospective, multicenter study. Hepatology. 2013;58(6):1378A.

Cho I, Yamanishi S, Cox L, Methé BA, Zavadil J, Li K, Gao Z, Mahana D, Raju K, Teitler I, Li H, Alekseyenko AV, Blaser MJ. Antibiotics in early life alter the murine colonic microbiome and adiposity. Nature. 2012;488(7413):621-626.

Chua DL, Hahambis T, Sigal SH. New-onset ascites as a manifestation of virologic relapse in patients with hepatitis C cirrhosis. Hepat Med. 2014;6:11-14.

Clutter DS, Dubrovskaya Y, Merl MY, Teperman L, Press R, Safdar A. Fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid organ and hematopoietic stem cell transplantation with Clostridium difficile-associated diarrhea. Antimicrob Agents Chemother. 2013;57(9):4501-4505.

Cohen SM, Nguyen AH, Pachter HL. Acute pancreatitis. In: Moore LJ, Turner KL, Todd SR, eds. Common Problems in Acute Care Surgery. New York, NY: Springer; 2013:303-316.

Collins A, Hatzaras I, Schmidt C, Carruthers K, Melvin WS, Muscarella P, Ellison EC, Martin E, Bloomston M. Gastrectomy in advanced gastric cancer effectively palliates symptoms and may improve survival in select patients. J Gastrointest Surg. 2014;18(3):491-496.

Court H, Amoyel M, Hackman M, Lee KE, Xu R, Miller G, Bar-Sagi D, Bach EA, Bergo MO, Philips MR. Isoprenylcysteine carboxylmethyltransferase deficiency exacerbates KRAS-driven pancreatic neoplasia via Notch suppression. J Clin Invest. 2013;123(11):4681-4694.

Cox LM, Yamanishi S, Sohn J, Alekseyenko AV, Leung JM, Cho I, Kim SG, Li H, Gao Z, Mahana D, Zarate Rodriguez JG, Rogers AB, Robine N, Loke P, Blaser MJ. Altering the intestinal microbiota during a critical developmental window has lasting metabolic consequences. Cell. 2014;158(4):705-721.

David A, Langnas E, Teperman C, Gelb B, Morgan G, Teperman L. PTC taste status and TAS2R38 genotype as a possible indicator for alcohol use in liver transplant patients. Am J Transplant. 2013;13(S5):221.

Feld JJ, Kowdley KV, Coakley E, Sigal S, Nelson DR, Crawford D, Weiland O, Aguilar H, Xiong J, Pilot-Matias T, DaSilva-Tillmann B, Larsen L, Podsadecki T, Bernstein B. Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med. 2014;370(17):1594-1603.

Gelb B, Layman R, Teperman L. Telaprevir based combination therapy for the treatment of recurrent HCV in liver transplant recipients: promising early results late disappointment. Am J Transplant. 2013;13(S5):347.

Glass N, Pinna A, Masi A, Rosman AS, Neihaus D, Okochi S, Saunders JK, Hatzaras I, Cohen S, Berman S, Pachter HL, Newman E, Gouge TH, Melis M. The surgical Apgar score is associated with the need for post-operative ICU admission. [published online January 19, 2015]. J Gastrointest Surg.

Grodstein E, Gelb B, Layman R, Mittal R, Teperman L. Nucleoside reverse transcriptase inhibitors without HBIG can be safely and cost-effectively administered to prevent recurrent hepatitis B viremia post-liver transplant. Am J Transplant. 2013;13(S5):352.

Gurvits GE, Marsano J, Kobrinsky B, Shin S, Sanfilippo N, Volkov D. Novel use of endoscopically placed fiducial markers for targeted radiation therapy of colonic lymphomas. Ann Gastroenterol. 2014;27(4):421-423.

Hasan N, Gross SA, Gralnek IM, Pochapin M, Kiesslich R, Halpern Z. A novel balloon colonoscope detects significantly more simulated polyps than a standard colonoscope in a colon model. Gastrointest Endosc. 2014 Dec;80(6):1135-1140.

Hatzaras I, Sachs TE, Weiss M, Wolfgang CL, Pawlik TM. Pancreaticoduodenectomy after bariatric surgery: challenges and available techniques for reconstruction. J Gastrointest Surg. 2014;18(4):869-877.

Henning JR, Graffeo CS, Rehman A, Fallon NC, Zambirinis CP, Ochi A, Barilla R, Jamal M, Deutsch M, Greco S, Ego-Osuala M, Bin-Saeed U, Rao RS, Badar S, Quesada JP, Acehan D, Miller G. Dendritic cells limit fibroinflammatory injury in nonalcoholic steatohepatitis in mice. Hepatology. 2013;58(2):589-602.

Hochberg MS, Berman RS, Kalet AL, Zabar SR, Gillespie C, Pachter HL. The stress of residency: recognizing the signs of depression and suicide in you and your fellow residents. Am J Surg. 2013;205(2):141-146.

Hochberg MS, Billig J, Berman RS, Kalet AL, Zabar SR, Fox JR, Pachter HL. When surgeons decide to become surgeons: new opportunities for surgical education. Am J Surg. 2014;207(2):194-200.

Jacobs RE, Bai S, Hindman N, Shah PC. Carcinoid abdominal crisis: a case report. J Surg Oncol. 2014;110(3):348-351.

Katz S, Surawicz C, Pardi DS. Management of the elderly patients with inflammatory bowel disease: practical considerations. Inflamm Bowel Dis. 2013;19(10):2257-2272.

Khan A, Serouya S, Poles MA, Traube M, Halahalli Srinivasa VM, Chen CT, Yang L, Pei Z, Francois F. A burning issue: defining GERD in non-erosive disease. Gastroenterology. 2013;144(5 suppl 1):S851.

SELECT PUBLICATIONS


Lee SC, Tang MS, Lim YA, Choy SH, Kurtz ZD, Cox LM, Gundra UM, Cho I, Bonneau R, Blaser MJ, Chua KH, Loke P. Helminth colonization is associated with increased diversity of the gut microbiota. PLoS Negl Trop Dis. 2014;8(5):e2880.

Leung JM, Davenport M, Wolff MJ, Wiens KE, Abidi WM, Poles MA, Cho I, Ullman T, Mayer L, Loke P. IL-22-producing CD4+ cells are depleted in actively inflamed colitis tissue. Mucosal Immunol. 2014;7(1):124-133.

Lin IH, Wu J, Cohen SM, Chen C, Bryk D, Marr M, Melis M, Newman E, Pachter HL, Alekseyenko AV, Hayes RB, Ahn J. Pilot study of oral microbiome and risk of pancreatic cancer. Cancer Research. 2013;73(8 suppl).

Lucey MR, Terrault N, Ojo L, Hay JE, Neuberger J, Blumberg E, Teperman LW. Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl. 2013;19(1):3-26.

Melis M, Pinna A, Marcon F, Miller G, Cohen SM, Pachter H, Newman E. Lymph node ratio and survival after resection of pancreatic adenocarcinoma. J Surg Res. 2013;179(2):194.

Melis M, Pinna A, Marcon F, Miller G, Cohen SM, Pachter H, Newman E. Pancreaticoduodenectomy with portal vein resection for pancreatic adenocarcinoma: a 10-year experience. J Surg Res. 2013;179(2):194.

Melis M, Pinna A, Okochi S, Masi A, Rosman AS, Neihaus D, Saunders JK, Newman E, Gouge TH. Validation of the Surgical Apgar Score in a veteran population undergoing general surgery. J Am Coll Surg. 2014;218(2):218-225.

Melis M, Rosen G, Hajdu CH, Pachter HL, Raccuia JS. Primary rhabdomyosarcoma of the diaphragm: case report and review of the literature. J Gastrointest Surg. 2013;17(4);799-804.

Mellgren A, Matzel K, Pollack J, Hull T, Bernstein MA, Graf W. Long term efficacy of NASHA Dx injection therapy (Solesta) for treatment of fecal incontinence. Neurogastroenterol Motil. 2014 Aug;26(8).

Merola J, Chaudhary N, Jow A, Charles HW, Teperman L, Sigal S. TIPS creation is tolerated by patients with portal vein thrombosis with high MELD scores. J Hepatol. 2013;58(suppl 1):S94.

Parikh M, Chung M, Sheth S, McMacken M, Zahra T, Saunders JK, Ude-Welcome A, Dunn V, Ogedegbe G, Schmidt AM, Pachter HL. Randomized pilot trial of bariatric surgery versus intensive medical weight management on diabetes remission in type 2 diabetic patients who do NOT meet NIH criteria for surgery and the role of soluble RAGE as a novel biomarker of success. Ann Surg. 2014;260(4):617-622.

Parikh M, Issa R, Vieira D, McMacken M, Saunders JK, Ude-Welcome A, Schubart U, Ogedegbe G, Pachter HL. Role of bariatric surgery as treatment for type 2 diabetes in patients who do not meet current NIH criteria: a systematic review and meta-analysis. J Am Coll Surg. 2013;217(3):527-532.

Ramkhelawon B, Hennessy EJ, Ménager M, Ray TD, Sheedy FJ, Hutchison S, Wanschel A, Oldebeken S, Geoffrion M, Spiro W, Miller G, McPherson R, Rayner KJ, Moore KJ. Netrin-1 promotes adipose tissue macrophage retention and insulin resistance in obesity. Nat Med. 2014;20(4):377-384.

Rao R, Graffeo CS, Gulati R, Jamal M, Narayan S, Zambirinis CP, Barilla R, Deutsch M, Greco S, Ochi A, Tomkotter L, Blobstein R, Avanzi A, Tippens DM, Gelbstein Y, Van Heerden E, Miller G. Interleukin 17-producing γδT cells promote hepatic regeneration in mice. Gastroenterology. 2014;147(2):473-484.e2.

Rao RS, Graffeo CS, Gulati R, Narayan S, Mohaimin T, Greco S, Tomkoetter L, van Heerden E, Barilla RM, Carazas O, Blobstein R, Gelbstein Y, Ochi A, Zambirinis CP, Deutsch M, Miller G. γδT cells promote liver regeneration via Dectin-1 dependent IL-17/IL-22 mediated inflammatory interplay. Hepatology. 2013;58(S1):311A.

Razavi F, Gross S, Katz S. Endoscopy in the elderly: risks, benefits, and yield of common endoscopic procedures. Clin Geriatr Med. 2014;30(1):133-147.

Rehman A, Hemmert KC, Ochi A, Jamal M, Henning JR, Barilla R, Quesada JP, Zambirinis CP, Tang K, Ego-Osuala M, Rao RS, Greco S, Deutsch M, Narayan S, Pachter HL, Graffeo CS, Acehan D, Miller G. Role of fatty-acid synthesis in dendritic cell generation and function. J Immunol. 2013;190(9):4640-4649.

Rielland M, Cantor DJ, Graveline R, Hajdu C, Mara L, de Diego Diaz B, Miller G, David G. Senescence-associated SIN3B promotes inflammation and pancreatic cancer progression. J Clin Invest. 2014;124(5):2125-2135.

Roslin MS, Dudiy Y, Brownlee A, Weiskopf J, Shah P. Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch. Surg Endosc. 2014;28(1):91-99.

Roslin MS, Oren JH, Polan BN, Damani T, Brauner R, Shah PC. Abnormal glucose tolerance testing after gastric bypass. Surg Obes Relat Dis. 2013;9(1):26-31.

Safdar A, Tulliano G, Teperman L, Press R. Enterococcal colonization and disease in solid-organ versus hematologic malignancy and hematopoietic stem cell transplantation units (2000–2011). Am J Transplant. 2013;13(S5):344.

Zambirinis CP, Barilla R, Ego-Osuala M, Blobstein R, Avanzi A, Markowitz J, Greco S, Deutsch M, Rao RS, Miller G. Gamma delta T cells regulate pancreatitis. J Am Coll Surg. 2013;217(3 suppl):S17-S18.

Zambirinis CP, Miller G. Signaling via MYD88 in the pancreatic tumor microenvironment: a double-edged sword. OncoImmunology. 2013;2(1):e22567.

Zambirinis CP, Pushalkar S, Saxena D, Miller G. Pancreatic cancer, inflammation, and microbiome. Cancer J. 2014 May-Jun;20(3):195-202.

Zambirinis CP, Pushalkar S, Saxena D, Miller G. Pancreatic cancer, inflammation, and microbiome. Cancer J. 2014;20(3):195-202.


LOCATIONS

1 NYU Langone Gastroenterology Ambulatory Care Center, 240 East 38th Street, New York, NY

2 NYU Langone Hepatology

530 First Avenue, Suite 4J, New York, NY

NYU Langone Colorectal Surgery 530 First Avenue, Suite 7V, New York, NY

NYU Langone General and Pancreas Surgery 530 First Avenue, Suite 6C, New York, NY

3 Laura and Isaac Perlmutter Cancer Center

160 East 34th Street, Ninth Floor, New York, NY

4 Joan H. Tisch Center for Women’s Health

207 East 84th Street, New York, NY

5 Preston Robert Tisch Center

for Men’s Health 555 Madison Avenue, Second Floor, New York, NY

6 NYU Langone at Trinity Center

111 Broadway, Second Floor, New York, NY

7 NYU Langone Ambulatory Care Center-

West Side 355 West 52nd Street, Sixth Floor, New York, NY

8 NYU Langone Transplant

403 East 34th Street, Third Floor, New York, NY

9 NYU Langone East 35th Street

245 East 35th Street, New York, NY

10 NYU Langone at Columbus Medical 97-85 Queens Boulevard, Rego Park, NY

11 NYU Langone at Great Neck

488 Great Neck Road, Great Neck, NY

12 NYU Langone Nassau Gastroenterology 1000 Northern Boulevard, Great Neck, NY

13 NYU Langone Brooklyn Gastroenterology 1630 East 14th Street, Brooklyn, NY

NYU Langone Brooklyn Endoscopy and Ambulatory Surgery Center 1630 East 14th Street, Brooklyn, NY

14 NYU Langone Levit Medical–Midwood 1220 Avenue P, Brooklyn, NY

NJ

MANHATTAN

STATEN ISLAND

NY

WESTCHESTER

BRONX

QUEENS

BROOKLYN

6

14

13

2

4

10

1112

3 89

5

1

Gastroenterology and GI Surgery


6 additional locations in Westchester

7

As of December 2014


CONTACT INFORMATION

H. Leon Pachter, MD


550 First Avenue NBV 15N1 New York, NY 10016 212.263.7669

[email protected]

For more information about our expert physicians, visit nyulmc.org

H. LEON PACHTER, MDGeorge David Stewart Professor of Surgery Chair of the Department of Surgery

COLORECTAL SURGERY

MITCHELL A. BERNSTEIN, MD Associate Professor of Surgery Director, Colon and Rectal Surgery

GI SURGERY RUSSELL S. BERMAN, MD Associate Professor of Surgery Director, General Surgery Residency Program Director, Surgical Oncology

GEORGE MILLER, MDAssociate Professor of Surgery and Cell Biology Vice Chair of Surgical Research

ELLIOT NEWMAN, MDProfessor, Surgery Director, GI Surgical Oncology

H. LEON PACHTER, MDGeorge David Stewart Professor of Surgery Chair of the Department of Surgery

PARESH C. SHAH, MD Professor of Surgery Director, General Surgery Vice Chair of Quality and Innovation

TRANSPLANTATION LEWIS W. TEPERMAN, MD Associate Professor of Surgery Director, Transplantation

MARK B. POCHAPIN, MDSholtz/Leeds Professor of Gastroenterology Professor of Medicine Director, Division of Gastroenterology Vice Chair of Clinical Affairs, Department of Medicine

GASTROENTEROLOGY AND HEPATOLOGY

ILSEUNG CHO, MDAssistant Professor of Medicine Master Scholars Career Advisor

FRITZ FRANÇOIS, MD Associate Professor of Medicine Chief of Medicine, Tisch Hospital

ADAM J. GOODMAN, MD Assistant Professor of Medicine Director of Endoscopy, Bellevue Hospital Center Associate Co-Director, Gastroenterology Fellowship Program

SETH A. GROSS, MDAssociate Professor of Medicine Gastroenterology Section Chief, Tisch Hospital Director of Endoscopy, Tisch Hospital

DAVID P. HUDESMAN, MDAssistant Professor of Medicine Director, Inflammatory Bowel Disease Program, Tisch Hospital

SEYMOUR KATZ, MDClinical Professor of Medicine Associate Director, Inflammatory Bowel Disease Program

ABRAHAM R. KHAN, MDAssistant Professor of Medicine Associate Director, Center for Esophageal Disease Associate Co-Director, Gastroenterology Fellowship Program

LISA B. MALTER, MDAssistant Professor of Medicine Director, Inflammatory Bowel Disease Clinic, Bellevue Hospital Center

JAMES S. PARK, MDAssistant Professor of Medicine Co-Director, Transplant Hepatology Director, Asian Liver Disease Program

MARK B. POCHAPIN, MD Sholtz/Leeds Professor of Gastroenterology Professor of Medicine Director, Division of Gastroenterology

MICHAEL A. POLES, MD, PhDAssociate Professor of Medicine, Microbiology, and Pathology Gastroenterology Section Chief, VA NY Harbor Healthcare System – Manhattan Director, Gastroenterology Fellowship Program

SAMUEL H. SIGAL, MDAssociate Professor of Medicine and Surgery Clinical Director, Hepatology Co-Director, Transplant Hepatology

HILLEL TOBIAS, MD, PhD Clinical Professor of Medicine and Surgery Medical Director, Liver Transplant

MORRIS TRAUBE, MD, JD Professor of Medicine Director, Center for Esophageal Disease

GERALD A. VILLANUEVA, MDClinical Associate Professor of Medicine Gastroenterology Section Chief, Bellevue Hospital Center

ELIZABETH H. WEINSHEL, MDProfessor of Medicine Director, Gastroenterology Faculty Development, Mentorship, and Leadership Program

LEADERSHIP

Mark B. Pochapin, MD


Ambulatory Care Center

240 East 38th Street 23rd Floor New York, NY 10016 646.501.2322

[email protected]


LEADERSHIP

NEW YORK UNIVERSITY

MARTIN LIPTON, Esq.Chair, Board of Trustees

JOHN SEXTONPresident

ROBERT BERNE, MBA, PhDExecutive Vice President for Health

NYU LANGONE MEDICAL CENTER

KENNETH G. LANGONEChair, Board of Trustees

ROBERT I. GROSSMAN, MDSaul J. Farber Dean and Chief Executive Officer

STEVEN B. ABRAMSON, MDSenior Vice President and Vice Dean for Education, Faculty and Academic Affairs

DAFNA BAR-SAGI, PhDSenior Vice President and Vice Dean for Science, Chief Scientific Officer

BERNARD A. BIRNBAUM, MDSenior Vice President and Vice Dean, Chief of Hospital Operations

ANDREW W. BROTMAN, MDSenior Vice President and Vice Dean for Clinical Affairs and Strategy, Chief Clinical Officer

MICHAEL T. BURKESenior Vice President and Vice Dean, Corporate Chief Financial Officer

RICHARD DONOGHUESenior Vice President for Strategy, Planning and Business Development

ANNETTE JOHNSON, JD, PhDSenior Vice President and Vice Dean, General Counsel

GRACE Y. KOSenior Vice President for Development and Alumni Affairs

KATHY LEWISSenior Vice President for Communications and Marketing

JOSEPH LHOTASenior Vice President and Vice Dean, Chief of Staff

VICKI MATCH SUNA, AIASenior Vice President and Vice Dean for Real Estate Development and Facilities

NADER MHERABISenior Vice President and Vice Dean, Chief Information Officer

NANCY SANCHEZSenior Vice President and Vice Dean for Human Resources and Organizational Development and Learning

NYU LANGONE MEDICAL CENTER by the numbers*

1,069 Total Number of Beds

77 Operating Rooms

35,666 Patient Admissions

1,061,552 Hospital-Based Outpatient Visits

5,422 Births

2,000,000 Faculty Group Practice Office Visits

1,408 Full-Time Faculty

1,047 Part-Time Faculty

2,500+ Voluntary Faculty

120 Endowed Professorships

2,515 Physicians

2,953 Registered and Advanced Practice Nurses

550+ Allied Health Professionals

4,000+ Publications

550,000 Square Feet of Research Space

$245MM NIH Funding

$285MM Total Grant Funding

2,053 Inventions

936 US Patents Issued

475 US Patents Licensed

650 MD Candidates

70 MD/PhD Candidates

252 PhD Candidates

415 Postdoctoral Fellows

1,155 Residents and Fellows

*Numbers represent FY14 (Sept 2013-Aug 2014); inventions/patents are cumulative through Aug 31, 2014


CONTENTS

1 Message from Leadership

2 Facts & Figures

4 New & Noteworthy

10 Microbiome

14 Clinical Care

15 Colon Cancer

18 Liver Disease

20 Esophageal Disease

22 Pancreatic Disease

24 Research

26 Publications

28 Locations

29 Leadership

Creative Direction: Ideas On Purpose, www.ideasonpurpose.com

Design: Craig Williams

Produced by: Office of Communications and Marketing, NYU Langone

CARDIAC AND VASCULAR INSTITUTE2014 YEAR IN REVIEW

NYU Langone Medical Center 550 First Avenue, New York, NY 10016

nyulmc.org

GASTROENTEROLOGY AND GI SURGERY - NYU … the past year, we have advanced our research program, our...

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