SAGES Research Grant:

Tailored Per-Oral Endoscopic Esophageal Based on 5 years Esophageal Function Testing for Achalasia Results in Identifying Predictors of Post-operative GERD or Recurrent Achalasia.

PI: Kristin Beard, MD2,

Co-Investigators: Ahmed M. Sharata MD1, Paul D. Colavita MD2, Ezra Teitelbaum MD2, Christy M. Dunst MD 1,2,3; Kevin Reavis MD 1,2,3, Lee L. Swanström MD.1,2,3

1. Foundation for Surgical Innovation and Education 2. Oregon Clinic GMIS Division 3. Providence Portland Medical Center

Contact: 4805 Northeast Glisan Street, Suite 6N50, Portland, OR, 97213 USA (503) 281-0561

Statement of Funding: There is no other pending or on hand funding for this project.

Duration of Project: 12 months

SUMMARY:

Introduction: Achalasia is an acquired, progressive esophageal motility disorder of failed esophagogastric junction (EGJ) relaxation and failed of the esophageal body that is surgically treatable with myotomy. Per oral endoscopic myotomy (POEM) is a minimally invasive technique first performed clinically in 2008 which allows a completely endoscopic myotomy that can be tailored specifically to each patient. This technique has now been utilized in hundreds of patients worldwide, and in over 100 patients at our center. However, long term outcomes data for patients treated with POEM are lacking given its recent development. Studies thus far have shown safety and efficacy of the procedure, but have also identified a considerable rate of postoperative GERD, which is not reliably symptomatic and may go undiagnosed without routine scheduled testing. We mandate periodic objective testing for postoperative POEM patients for this reason. Impedance planimetry measurement with a trans-orally inserted functional lumen-imaging probe (EndoFLIP) technology allows effective, on the spot distensibility measurement of the esophageal lumen during . EndoFLIP is used to guide the length and extent of myotomy at our center before and after myotomy during POEM intra- operatively. EndoFLIP measurements have been shown to correlate with reflux. Our group’s experience with POEM is approaching the 5 year mark, with those patients due for follow up symptom evaluation and objective testing – longer objective follow up than has ever been reported for POEM thus far. We propose the addition of repeat EndoFLIP evaluation in 5 year postoperative patients during regular follow up endoscopy. We aim to examine changes in distensibility and cross-sectional surface area over time as compared to pre and post myotomy, as well as determine correlation between these current measures and symptoms, to determine if intra-operative distensibility results may be predictive of changes over time. The ultimate aim is to provide guidelines for tailored myotomy that provides reliable, durable relief of achalasia while minimizing the incidence of GERD.

Methods:

POEM patients at our center are tracked in a secure database with their permission by previous participation in IRB approved study. Follow up with exam, Eckhart symptom scoring, as well as pH, manometry, contrast swallow, and endoscopy are already clinically indicated and standard in our practice, including at 5 years post POEM. We will identify 45 achalasia patients treated with POEM 5 years ago using intraoperative pre and post myotomy EndoFLIP measurement to participate in this study as part of their routine follow up. All patients will be contacted to schedule these 5 year follow up studies and will be consented for EndoFLIP evaluation to be completed during the upper endoscopy. Endoscopy will be performed by one of the surgeon investigators of this study assisted by a surgical fellow or surgical resident. Procedures will be performed in a hospital endoscopy center or at an ambulatory center with conscious sedation. Monitored recovery will be provided per usual standards

BACKGROUND

Achalasia is a primary esophageal motility disorder that manifests as failed peristalsis of the esophageal body and failed esophagogastric junction (EGJ) relaxation [1]. Symptoms of this progressive disease can include , chest pain, and regurgitation. The disease puts patients at risk for aspiration, malnutrition, weight loss, complete esophageal failure requiring eventual , and increases risk of esophageal cancer [2]. The underlying etiology of achalasia is not completely understood and a definitive cure has not been established, so treatment is symptom directed. Symptomatic relief can be achieved by allowing relaxation of esophageal smooth muscle to relieve EGJ outlet obstruction. Pharmacologic therapy options are limited in efficacy and available drugs have some significant side effects [3, 4]. Endoscopic botulinum toxin therapy is more effective, but short-lived, often require multiple repeat treatments, and resulting fibrosis can make definitive surgical treatment more challenging. Pneumatic dilation has also effective but with 3-6% rate of perforation, so it is no longer widely performed in the United States [4, 5]. The standard surgical treatment is the laparoscopic Heller myotomy with or without partial fundoplication [6]. POEM was first established by Inoue in 2008 as a less invasive natural orifice transluminal endoscopic surgical (NOTES) technique which consists of endoscopic creation of a submucosal tunnel and circular muscle myotomy. This technique was instituted at our center in 2010, where more than 100 cases have since been performed [7, 8].

As an adjunct to preoperative endoscopy, barium swallow, and manometry findings, we use functional lumen-imaging planimetry (EndoFLIP®), intra-operatively immediately prior to and following creation of the esophageal myotomy to provide immediate measurable and visual data (Figure 1). This technique uses a trans oral probe with impedance planimetry with 16 electrodes to measure CSAs at 5-mm intervals inside a saline- filled bag (length= 80 mm). Intra-balloon pressure (PRS) is assessed, the relationship of CSA and pressure (distensibility) of the EGJ can be evaluated. Diameter (mm), CSA (mm2), and distensibility indices (DI, mm2/mmHg) are measured.) [9] This technology allows on-site calculation and topographic visualization of cross-section area (CSA) and combines this with pressure evaluations to determine distensibility of the EGJ to guide our plan for the extent of the myotomy, and to double check the adequacy of the myotomy prior to completion of the procedure. [10, 11] Esophageal distensibility has been shown to be an important predictor of gastroesophageal reflux. [12] POEM has been shown by our group and several others internationally to be safe and efficacious for the surgical treatment of achalasia. Outcomes data worldwide is limited thus far between 6 months-3 years, with much of this data based on subjective symptoms scores and limited, selective objective testing. [8, 13-15] In contrast to conventional Heller myotomy, division of only the inner circular esophageal muscle layer and sling fibers leaves longitudinal muscle and crural diaphragm components of the EGJ intact, theoretically avoiding reflux disease to some extent. However, our follow up for patients treated with POEM identified postoperative GERD still affects around 39% of patients by pH impedance testing, though only less than half of those patients experienced reflux symptoms [8, 15]. This compares to a rate between 21-32% or more in objective studies of Heller myotomy with partial fundoplication [16,17]. It is yet to be determined if further tailoring the length or extent of the myotomy has a reliable effect on postoperative GERD. Considering the high rate of silent GERD after POEM, we take care to ensure regular follow up of POEM patients with objective testing. This includes periodic esophageal manometry, pH impedance, endoscopy, and timed barium swallow to completely evaluate postoperative parameters of motility and reflux. Our center is now approaching the 5 year anniversary of its first POEM case. We propose a study to re-evaluate patients 5 years after POEM with objective follow up testing, such long-term objective follow up has not yet been reported by any center. In addition to the routine battery of esophageal tests previously mentioned we propose to include distensibility testing with EndoFLIP technology at 5 year follow up during routinely scheduled endoscopy. We propose that this information can help guide treatment for patients after POEM (as early as during the same endoscopy) and guide technical surgical decisions in future POEM cases by identifying predictors of GERD or recurrent achalasia. Our goal is to provide new improved guidelines for tailoring the myotomy intraoperatively with EndoFLIP as an adjunct to traditional studies, in order to provide durable symptom relief of achalasia while decreasing incidence of iatrogenic GERD.

Figure 1[15]

Hypothesis:

Five years after POEM for achalasia, measurements of esophageal physiology collected by EndoFLIP may have changed compared to intra-operative measurements. Establishing the pattern of EndoFLIP measurements 5 years after POEM in correlation with symptom scores, HRM, pH, esophagram, and endoscopy may help to identify predictors of post-operative GERD or recurrent achalasia. These predictors could inform the surgeon’s strategy for tailoring length and extent of myotomy in future POEM cases.

Specific Aims:

1) Establish patterns of distensibility and cross sectional area in correlation with clinical outcomes 5 years after POEM. 2) Compare patterns of distensibility and cross sectional area intraoperatively and at 5 years after POEM 3) Retrospectively identify intra-operative distensibility and cross sectional area patterns predictive of development of GERD; utilize these predictors to propose improved strategies for tailored myotomy.

Power Analysis:

Based on our expected rate of objective GER of 39% for POEM and a best result known rate of objective GER of 21% in long term follow up in patients undergoing a myotomy with fundoplication [16] we would require a sample size of at least 45 patients (α = 0.05, β 0.2, 80% power).

Methods:

POEM patients at our center are tracked in a secure database with their permission by participation in an ongoing IRB approved study. Follow up with exam, Eckhart symptom scoring, and objective pH, manometry, contrast swallow, and endoscopy are standard for these patients, including at 5 years post operatively. We will identify 45 achalasia patients treated with POEM with intra-operative pre and post myotomy EndoFLIP to participate in this study as part of their routine follow up. All patients will be contacted to schedule these 5 year follow up studies and will be consented for EndoFLIP evaluation during the upper endoscopy. Endoscopy will be performed by one of the surgeon investigators of this study assisted by a surgical fellow or surgical resident. Procedures will be performed in the hospital endoscopy center or at an ambulatory surgery center. Conscious sedation will be administered per usual standards. Monitored recovery will be provided per usual standards. EndoFLIP data will be recorded and interpreted by the investigators.

INSTITUTIONAL REVIEW BOARD:

We will submit an addendum to our present POEM IRB at Providence Health (IRB # 10-117A) for the addition of EndoFLIP testing.

SAGES RESEARCH GRANT APPLICATION

BUDGET SHEET

Detailed budget for 12 month period from 12/5/15 through 12 /5/16 .

Dollar amount requested $27,800

NAME POSITION TITLE TIME/EFFORT SALARY FRINGE SUB-TOTALS BENEFITS

Hrs/ % Week

Kristin Beard Principal Investigator* Ahmed Sharata, Paul Colavita, Christy Dunst, Kevin Reavis, Lee Swanstrom 0

Research Coordinator $2000 $2000 CONSULTANT COSTS 0 EQUIPMENT (List all Items&Total Equipment Cost) EndoFLIP machine $8000 SUPPLIES (List all Items&Total Supplies Cost) $340/catheter x 45 patients = $17000 TRAVEL** $1000

PATIENT CARE COSTS

CONSORTIUM/CONTRACTUAL COSTS OTHER EXPENSES (List all Items & Total Cost) IRB addendum $1500 TOTAL DIRECT COSTS 27,800.00

References

1. Kahrilas, P.J., et al., The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterology & Motility, 2015. 27(2): p. 160-174. 2. O'Neill, O.M., B.T. Johnston, and H.G. Coleman, Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol, 2013. 19(35): p. 5806-12. 3. Zerbib, F. and S. Roman, Current Therapeutic Options for Esophageal Motor Disorders as Defined by the Chicago Classification. J Clin Gastroenterol, 2015. 49(6): p. 451-60. 4. Rohof, W.O., et al., Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology, 2013. 144(4): p. 718-25; quiz e13-4. 5. Leyden, J.E., A.C. Moss, and P. MacMathuna, Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev, 2006(4): p. Cd005046. 6. Pehlivanov, N. and P.J. Pasricha, Achalasia: botox, dilatation or laparoscopic surgery in 2006. Neurogastroenterol Motil, 2006. 18(9): p. 799-804. 7. Inoue, H., et al., Peroral endoscopic myotomy (POEM) for . Endoscopy, 2010. 42(4): p. 265-71. 8. Sharata, A., et al., Peroral Endoscopic Myotomy (POEM) for Esophageal Primary Motility Disorders: Analysis of 100 Consecutive Patients. Journal of Gastrointestinal Surgery, 2015. 19(1): p. 161-170. 9. Rieder, E., et al., Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders. Surg Endosc, 2013. 27(2): p. 400-5. 10. McMahon, B.P., et al., A new technique for evaluating function in visceral organs: application of the functional lumen imaging probe (FLIP) for the evaluation of the oesophago-gastric junction. Physiol Meas, 2005. 26(5): p. 823-36. 11. Pandolfino, J.E., et al., Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe (FLIP) in achalasia patients. Neurogastroenterol Motil, 2013. 25(6): p. 496-501. 12. Pandolfino, J.E., et al., Esophagogastric junction distensibility: a factor contributing to sphincter incompetence. Am J Physiol Gastrointest Physiol, 2002. 282(6): p. G1052-8. 13. Inoue, H., et al., Per-Oral Endoscopic Myotomy: A Series of 500 Patients. Journal of the American College of Surgeons, 2015. 221(2): p. 256-264. 14. Sharata, A., et al., Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention. J Gastrointest Surg, 2013. 17(7): p. 1188-92. 15. Swanstrom, L.L., et al., Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg, 2012. 256(4): p. 659-67. 16. Rawlings, A et al., Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter prospective, randomized-controlled trial. Surg Endosc. 2012 Jan;26(1):18-26. 17. Bhayani NH, et al., A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014 Jun;259(6):1098-103.

OMB No. 0925-0001/0002 (Rev. 08/12 Approved Through 8/31/2015)

BIOGRAPHICAL SKETCH Provide the following information for the Senior/key personnel and other significant contributors.

Follow this format for each person. DO NOT EXCEED FIVE PAGES. NAME: Beard, Kristin eRA COMMONS USER NAME (agency login): POSITION TITLE: EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable.) INSTITUTION AND LOCATION DEGREE Completion FIELD OF STUDY (if Date applicable) MM/YYYY Pittsburg State University, Pittsburg, Kansas OTH 05/2003 Biology University of Kansas, Kansas City, Kansas AB 05/2006 1) Human Biology 2) Anthropology University of Kansas School of Medicine, Kansas City, MD 05/2010 Kansas University of Texas Southwestern, Dallas, Texas Resident 06/2015 General Surgery Residency Providence Portland Medical Center, Portland, Oregon Fellow present Minimally Invasive Surgery Fellowship

A. Personal Statement

I am originally from a small town in Kansas. I was inspired to become a physician by my parents, a school teacher and steel draftsman, as well as my high school teachers. I studied biology at Pittsburg State University, then transferred to The University of Kansas where I received a dual Bachelor of Arts in Human Biology and Anthropology. I moved on to medical school at The University of Kansas School of Medicine in Kansas City. I had very fulfilling experience volunteering on the board of directors for a free medical clinic, and expected to continue with a career in primary care as I entered the clinical portion of medical school. Ultimately I found my passion for medicine in surgery, working with my hands and providing immediate relief of disease. I completed a fellowship in General Surgery at the University of Texas Southwestern where I gained incredibly valuable education and experience as a developing surgeon and tailored my interest in Minimally Invasive Surgery. I am currently a fellow in Minimally Invasive Surgery at Providence Portland Medical Center in Portland, Oregon. My training is provided by members of The Oregon Clinic who are known pioneers in the practice and study of Minimally Invasive Surgery. I am currently seeking a career with emphasis in Minimally Invasive Foregut, Bariatric, and General Surgery.

B. Positions and Honors

Positions and Employment

Other Experience and Professional Memberships 2013 - 2015 Member, American College of Surgeons 2015 - Member, SAGES

Honors 2005 University of Kansas Outstanding Woman in Community Service Award , Emily Taylor Women’s Resource Center

C. Contribution to Science

1. Poster Presentation - North Texas Chapter of the American College of Surgeons, February, 2014 Let safety razor blades pass after intentional ingestion. Beard K, Hranjec T, Ali-Osman F, Luk S

2. Podium Presentation - University of Texas Southwestern, May 2015 Reduction of OR time in laparoscopic quality improvement project. Beard KW, Eastman A

3. SAGES Abstract Submission 2015 – Video and Abstract “Laparoscopic for Menetrier’s Disease.” Beard K, Sharata A, Colavita P, Dunst C, Reavis K, Swanstrom L D. Research Support none

BIOGRAPHICAL SKETCH Provide the following information for the Senior/key personnel and other significant contributors in the order listed on Form Page 2. Follow this format for each person. DO NOT EXCEED FOUR PAGES.

NAME POSITION TITLE Paul D Colavita Minimally Invasive Surgery/Foregut Fellow eRA COMMONS USER NAME (credential, e.g., agency login) N/A EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable.) DEGREE INSTITUTION AND LOCATION (if MM/YY FIELD OF STUDY applicable) Duke University- Durham, NC B.S.E. 05/04 Biomedical Engineering University of North Carolina- Chapel Hill, NC M.D. 05/09 Medicine

Carolinas Medical Center- Charlotte, NC N/A 06/15 General Surgery Residency & 1 year research fellowship (2011-2012)

Providence Portland Medical Center N/A 06/16 Minimally Invasive Surgery Fellowship

NOTE: The Biographical Sketch may not exceed four pages. Follow the formats and instructions below.

B. Positions and Honors AWARDS/RECOGNITIONS

Basic Science Achievement Award, Carolinas Medical Center, Charlotte, NC. June 22nd, 2010. Given to the individual surgical resident in each class that obtains the highest score on the ABSITE exam.

ABSITE Achievement Award, Carolinas Medical Center, Charlotte, NC. June 16th, 2011. Given to the surgical resident with the highest score on the ABSITE exam.

Bassini Prize, 7th Annual Asia Pacific Society Meeting, Hua-Hin, Thailand. January 10th-13th, 2012. Awarded for best oral scientific presentation.

First Place Award, 2012 SAGES Residents and Fellows Scientific Session. San Diego, Ca. March 9th, 2012. Awarded for the best oral scientific presentation in the Resident and Fellow Scientific Session at the annual SAGES meeting.

Best Resident/Fellow Paper, 5th International Hernia Congress, joint meeting of the American Hernia Society and European Hernia Society. New York, NY. March 28th-31st, 2012. Awarded for best resident/fellow oral scientific presentation.

2nd place, North Carolina/South Carolina American College of Surgeons Committee on Trauma, Resident Trauma Paper Competition, Myrtle Beach, SC. July 13, 2012.

1st place, North Carolina/South Carolina American College of Surgeons Resident Paper Competition, Myrtle Beach, SC. July 14, 2012.

Touchstone Award – Carolinas Healthcare System, Charlotte, NC. July 25th, 2012. 2012 CHS Quality & Service Sharing Day; Bronze Award for “A Software Application for Patient Education and Quality of Life Prediction after Inguinal ”

Gold Medal Forum, Southeastern Surgical Congress 2013 Meeting, Jacksonville, FL, February 9th-12th, 2013.

Best Resident/Fellow Paper, 2013 Americas Hernia Society Annual Meeting, Orlando, FL. March 14th-16th, 2013. Awarded for best resident/fellow oral scientific presentation.

Most Innovative Award, Carolinas HealthCare System Resident Scholarship Poster Reception. Carolinas Medical Center, Charlotte, NC. May 2nd, 2013.

Best Papers Session, European Hernia Society Annual Meeting, Gdansk, Poland, May 11th, 2013.

M. Judah Folkman Memorial Award for best clinical science presentation at the American Pediatric Surgical Association Annual Meeting, May 29-June 1st, 2014.

Touchstone Award – Carolinas Healthcare System, Charlotte, NC. 2014 CHS Quality & Service Sharing Day; Gold Award for “A decade of experience in open ventral hernia repair with mesh: shaping the future of surgical decision making and health system policy.”

1st place Plenary Presentation -- Carolinas Medical Center Department of Surgery Research Symposium. “Home Intravenous versus Oral Antibiotics Following for Perforated Appendicitis in Children: A Randomized Controlled Trial”

ORGANIZATION MEMBERSHIPS Society of American Gastrointestinal and Endoscopic Surgeons: 2009- Present SAGES Hernia Taskforce: 2015-Present American College of Surgeons: 2009- Present Society for Surgery of the Alimentary Tract: 2012-Present Mecklenburg County Medical Society: 2013-Present North Carolina Chapter of the American College of Surgeons: 2013- Present American Medical Association: 2013-Present Journal of the Society of Laparoendoscopic Surgeons, Resident-Fellow Reviewer: 2014 Americas Hernia Society: 2015-Present Americas Hernia Society Residency Committee: 2015- Present C. Selected Peer-reviewed Publications Zemlyak AY, Colavita PD, El Djouzi S, Walters AL, Hammond L, Hammond B, Tsirline VB, Getz SB, Heniford BT. Comparative study of wound complications: isolated panniculectomy versus panniculectomy combined with ventral hernia repair. J Surg Res. 2012 Oct;177(2):387-91.

Colavita PD, Tsirline VB, Belyanksy I, Walters AL, Lincourt AE, Sing RF, Heniford BT. Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg. 2012 Nov;256(5):714- 22; discussion 722-3.

Tsirline VB, Zemlyak AY, Avery MJ, Colavita PD, Lincourt AE, Christmas AB, Heniford BT, Sing RF. is superior to neostigmine in the treatment of Ogilvie’s syndrome. Am J Surg. 2012 Dec;204(6):849-55; discussion 855.

Colavita PD, Tsirline VB, Walters AL, Lincourt AE, Belyansky I, Heniford BT. Laparoscopic versus open hernia repair – outcomes and sociodemographic utilization results from the Nationwide Inpatient Sample. Surg Endosc. 2013 Jan;27(1):109-17.

Colavita PD, Belyansky I, Walters AL, Tsirline VB, Zemlyak AY, Lincourt AE, Heniford BT. Nationwide Inpatient Sample: Have Antireflux Procedures Undergone Regionalization? J Gastrointest Surg. 2013 Jan;17(1):6-13; discussion p.13.

Colavita PD, Walters AL, Tsirline VB, Belyansky I, Lincourt AE, Kercher KW, Sing RF, Heniford BT. The Regionalization of Ventral Hernia Repair: Occurrence and Outcomes over a Decade. Am Surg. 2013 Jul;79(7):693-701.

Williams KB, Bradley JF 3rd, Wormer BA, Zemlyak AY, Walters AL, Colavita PD, Lincourt AE, Tsirline VB, Belyansky I, Heniford BT. Postoperative Quality of Life Following Open Transinguinal Preperitoneal Inguinal Hernia Repair Using Memory Ring or Three-Dimensional Devices. Am Surg. 2013 Aug; 79(8):786-93

Tsirline VB, Colavita PD, Belyansky I, Zemlyak AY, Lincourt AE, Heniford BT. Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair. Am Surg. 2013 Aug;79(8):829-36.

Colavita PD, Tsirline VB, Belyansky I, Swan RZ, Walters AL, Lincourt AE, Iannitti DA, Heniford BT. Regionalization and Outcomes of Hepato-pancreato-biliary Cancer Surgery in the United States, Analysis of the Nationwide Inpatient Sample. J Gastrointest Surg. 2014 Mar; 18(3):532-41.

Colavita PD, Belyansky I, Walters AL, Zemlyak AY, Lincourt AE, Heniford BT, Augenstein VA. Umbilical hernia repair with mesh: identifying effectors of ideal outcomes. Am J Surg. 2014 Sep; 208(3):342-9.

Fischer PE, Colavita PD, Fleming G, Huynh TT, Christmas AB, Sing RF. Delays in transfer of elderly less-injured trauma patients can have deadly consequences. Am Surg. 2014 Nov; 80(11): 1132-5.

Wormer BA, Colavita PD, Yokeley WT, Bradley JF, Williams KB, Walters AL, Green JM, Heniford BT. Impact of implementing an electronic health record on surgical resident work flow, duty hours, and operative experience. Am Surg. 2015 Feb; 81(2): 170-5.

Colavita PD, Wormer BA, Belyansky I, Lincourt AE, Getz SB, Heniford BT, Augenstein VA. Intraoperative indocyanine green fluorescence angiography to predict wound complications in complex ventral hernia repair. Hernia. Epub ahead of print.

D. Research Support Heniford BT, Belyansky I, Colavita PD, Lincourt AE, Tsirline VB, Walters AL, Zemlyak AY. “Hernia Apps for Prediction of Postoperative Quality of Life.” Ethicon Education Grant - $87,588.00.

This grant supported development of the first of two mobile phone/tablet applications that were created by our group (CeQOL and CeDAR- both available in the Apple® and Android™ app stores). I helped create the algorithm behind the application that predicted quality of life after inguinal hernia repair (CeQOL) and wound complications and postoperative charges after ventral hernia repair (CeDAR), as well as helped with design of the user-interface for the first generation CeQOL app and authored the hernia e-book included with the apps.

LifeCell Innovative Studies and Investigational Support Program Grant. "A randomized, prospective, double blinded clinical trial using Spy Elite System in planning tissue advancement flaps and reducing wound complications after complex ventral hernia repairs." - $199,527.30

This grant supported the randomized controlled trial described above in section A. I designed the trial, participated in the clinical study, was involved in post-study data analysis, and am an author on the study currently in evaluation for acceptance.

BIOGRAPHICAL SKETCH Provide the following information for the key personnel and other significant contributors in the order listed on Form Page 2. Follow this format for each person. DO NOT EXCEED FOUR PAGES.

NAME POSITION TITLE Ahmed sharata Notes/ Advanced endoscopy fellow, Oregon Clinic eRA COMMONS USER NAME: Ahmed Sharata Portland, OR

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) DEGREE INSTITUTION AND LOCATION YEAR(s) FIELD OF STUDY (if applicable) University of Tripoli, Tripoli Libya MBBCH 2003 Medicine

Tripoli Medical Center Resident 2003 – 2008 Surgery

Oregon Clinic/ GMIS Fellowship 2011 – 2013 Research Fellowship

Oregon Clinic/ GMIS Fellowship 2013 – Advanced GI/ NOTES present Fellowship

A. Personal Statement

B. Positions and Honors

Positions and Employment

2013- Faculty: The Foundation for Surgical Innovation and Education (TFSIE), Oregon Clinic: Per-Oral Endoscopic Esophageal Myotomy surgery (hands-on POEM course experience)

2013- NOTES Fellow, GMIS devision, Oregon Clinic, Portland, OR

2011-2013 Research fellow, GMIS devision, Oregon Clinic, Portland, OR

2003-2008 Resident, General Surgery Department, Tripoli Central Hospital, Libya Other Experience and Professional Memberships

2012 Member, Society of American Gastrointestinal and Endoscopic Surgeon

2013 Member, Society for Surgery of the Alimentary Tract (SSAT)

Honors

- Awarded Libyan Ministry of Higher Education Scholarship for Academic Excellence - Graduated in fifth percentile.

- Awarded teacher’s assistant position for academic excellence.(7th of April University, Faculty of Medicine

- Invited Presenter: SSAT (Society for Surgery of the Alimentary Tract) Residents and Fellows Research Conference

C. Selected Peer-reviewed Publications 1- Sharata AM, Dunst CM, Pescarus R, Shlomovitz E, Kurian A, Reavis KM, Swanström LL: Sleeve Endoscopic Esophageal Mucosotomy (SEEM). Gastrointest Endosc. 2015 May;81(5):1253. doi: 10.1016/j.gie.2014.09.045. Epub 2015 Jan 16. PubMed PMID: 25597421.

2- Sharata A, Dunst CM, Pescarus R, Shlomovitz E, Wille AJ, Reavis KM, Swanström LL: Peroral Endoscopic Myotomy (POEM) for Esophageal Primary Motility Disorders: Analysis of 100 Consecutive Patients. J Gastrointest Surg. 2015 Jan;19(1):161-70. doi: 10.1007/s11605-014-2610-5. Epub 2014 Sep 3. PubMed PMID: 25183406.

3- Sharata A, Kurian AA, Dunst CM, Bhayani NH, Reavis KM, Swanstrom LL: Technique of per-oral endoscopic myotomy (POEM) of the (with video). Surg Endosc. 2014 Apr;28(4):1333. doi: 10.1007/s00464-013-3332-6. Epub 2014 Feb 26. PubMed PMID: 24570010.

4- Sharata A, Aliabadi-Wahle S, Bhayani NH, Kurian AA, Reavis KM, Dunst CM, Swanstrom LL: Subxyphoid thyroidectomy: a feasibility study. Surg Innov. 2014 Apr;21(2):194-7. doi: 10.1177/1553350613497431. Epub 2013 Jul 30. PubMed PMID: 23899620.

5- Sharata A, Bhayani NH, Dunst CM, Kurian AA, Reavis KM, Swanström LL: Gastro-bronchial fistula closed by endoscopic fistula plug (with video). Surg Endosc. 2014 Dec;28(12):3500-4. doi: 10.1007/s00464-014-3631-6. Epub 2014 Jul 4. PubMed PMID: 24993168.

6- Hunt BM, Louie BE, Dunst CM, Lipham JC, Farivar AS, Sharata A, Aye RW: Esophagectomy for failed endoscopic therapy in patients with high-grade dysplasia or intramucosal carcinoma. Dis Esophagus. 2014 May-Jun;27(4):362-7. doi: 10.1111/dote.12096. Epub 2013 Jun 24. PubMed PMID: 23795720.

7- Sharata A, Kurian AA, Dunst CM, Bhayani NH, Reavis KM, Swanström LL. “Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic Intervention”. J Gastrointest Surg. 2013 Jul ;17(7):1188-92. doi:10.1007/s11605-013-2193-6. Epub 2013 Apr 23.

8- Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL. “Peroral endoscopic esophageal myotomy: defining the learning curve”. Gastrointest Endosc. 2013 May;77(5):719-25. doi:10.1016/j.gie.2012.12.006. Epub 2013 Feb 5.

9- Kurian AA, Bhayani N, Sharata A, Reavis K, Dunst CM, Swanström LL. “Partial anterior vs partial posterior fundoplication following transabdominal esophagocardiomyotomy for achalasia of the esophagus: meta-regression of objective postoperative gastroesophageal reflux and dysphagia”. JAMA Surg. 2013 Jan ;148(1):85-90. doi: 10.1001/jamasurgery.2013.409

10- Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E. “Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure”. Ann Surg. 2012 Oct;256(4):659-67. Doi: 10.1097/SLA.0b013e31826b5212.

11- Bhayani NH, Kurian AA, Sharata AM, Reavis KM, Dunst CM, Swanstrom LL. “Wait only to resuscitate: early surgery for acutely presenting paraesophageal yields better outcomes”. Surg Endosc. 2013 Jan;27(1):267-71. doi:10.1007/s00464-012-2436-8. Epub 2012 Jun 21.

12- Bhayani NH, Gupta A, Kurian AA, Dunst CM, Sharata AH, Reavis KM, Swanstrom LL, Halpin VJ. “Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes?' Surg Endosc. 2012 Dec;26(12):3442-8. doi:10.1007/s00464-012-2360-y. Epub 2012 May 31.

13- Kurian AA, Bhayani N, Sharata A, Reavis KM, Dunst CM, Swanstrom LL: “The Impact of Impedance (MII) Testing on Patient Selection for Anti-Reflux Surgery in the setting of a Normal 24-Hour pH Test.” Gastroenterol 2012 142: 5,S-1074.

TEXTBOOK CHAPTER:

1- Ahmed Sharata, Lee L. Swanström: Endoscopic Tools and Techniques for Fistula and Leaks : Principles of Flexible Endoscopy for Surgeons: Publisher Springer New York.

BIOGRAPHICAL SKETCH

NAME POSITION TITLE

Ezra N. Teitelbaum, MD General Surgery Resident eRA COMMONS USER NAME (credential, e.g., agency login) EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable.) DEGREE INSTITUTION AND LOCATION MM/YY FIELD OF STUDY (if applicable)

University of Chicago B.A. 6/04 Visual Art

Mount Sinai School of Medicine M.D. 5/08 Medicine

University of Cincinnati M.Ed. 5/14 Education

A. Positions and Honors

Positions and Employment

2008 – 2011 General Surgery Resident (Clinical years 1-3), George Washington University

2011 – 2014 Minimally Invasive Surgery Research Fellow, Northwestern University

2014 – expected 2016 General Surgery Resident (Clinical years 4-5), Northwestern University

Matched to start 8/2016 Fellow, MIS/Foregut Surgery, Providence Portland Medical Center

Honors

2004 Louis Sudler Prize in the Performing and Creative Arts, University of Chicago

2005 Training grant recipient, Medical Student Summer Research Training in Aging Program, American Federation for Aging Research (AFAR) 2009 Outstanding Resident Teacher Award, George Washington University Department of Surgery

2012 Resident Clinical Research Award, Edlestone-Bendix Research Day, Northwestern University Department of Surgery

2014 Winning team member, Award for Excellence in Innovation, Association for Surgical Education

2014 SAGES Recognition of Excellence Award Coin. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) – Surgical Spring Week. Salt Lake City, UT. April 3rd, 2014. Presented by Dr. Daniel Jones for development and execution of the “Hands-On Course: CBD Stones”

2014 1st Prize, Best Resident/Fellow Presentation - Resident/Fellow Presentation Session. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) – Surgical Spring Week. Salt Lake City, UT. April 4th, 2014.

2014 SAGES Researcher in Training Award, Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

2014 Resident Clinical Research Award, Edlestone-Bendix Research Day, Northwestern University Department of Surgery

B. Selected Peer-Reviewed Publications

1. Nguyen SQ, Teitelbaum E, Sabnis AA, Bonaccorso A, Tabrizian P, Salky B. Laparoscopic resection for Crohn's disease: an experience with 335 cases. Surg Endosc. 2009;23(10):2380-4.

2. Santos BF, Teitelbaum EN, Arafat FO, Milad MP, Soper NJ, Hungness ES. Comparison of Short-Term Outcomes between Transvaginal Hybrid NOTES Cholecystectomy and Laparoscopic Cholecystectomy. Surg Endosc. 2012;26(11):3058-66.

3. Arafat FO, Teitelbaum EN, Hungness ES. Modern Treatment of Paraesophageal Hernias: Preoperative Evaluation and Technique for Laparoscopic Repair. Surg Laparosc Endosc Percutan Tech. 2012;22(4):297-303.

4. Hungness ES, Teitelbaum EN, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, Soper NJ. Comparison of Perioperative Outcomes Between Peroral Esophageal Myotomy (POEM) and Laparoscopic Heller Myotomy. J Gastrointest Surg. 2013;17(2):228-35.

5. Nicodème F, de Ruigh A, Xiao Y, Rajeswaran S, Teitelbaum EN, Hungness ES, Kahrilas PJ, Pandolfino JE. A Comparison of Symptom Severity and Bolus Retention to Chicago Classification Esophageal Pressure Topography Metrics in Patients with Achalasia. Clin Gastroenterol Hepatol. 2013;11(2):131-7.

6. Teitelbaum EN, Hungness ES. POEM peri-procedural evaluation: predicting and measuring outcomes. Tech Gastroinstest Endosc. 2013;15(3):135-9. 7. Teitelbaum EN, Hungness ES. Therapeutic flexible endoscopy replacing surgery: Part 3 – Peroral esophageal myotomy. Tech Gastroinstest Endosc. 2013; 15(4):211-5.

8. Teitelbaum EN, Soper NJ, Arafat FO, Santos BF, Kahrilas PJ, Pandolfino JE, Hungness ES. Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM). J Gastrointest Surg. 2014;18(1):92-9.

9. Teitelbaum EN, Boris L, Arafat FO, Nicodème F, Lin L, Kahrilas PJ, Pandolfino JE, Soper NJ, Hungness ES. Comparison of esophagogastric junction distensibility changes during POEM and Heller myotomy using intraoperative FLIP. Surg Endosc. 2013;27(12):4547-55.

10. Teitelbaum EN, Rajeswaran S, Zhang R, Sieberg R, Miller FH, Soper NJ, Hungness ES. Peroral Esophageal Myotomy (POEM) and Laparoscopic Heller Myotomy Produce a Similar Short-Term Anatomic and Functional Effect. Surgery. 2013;154(4):885-92.

11. Cho YK, Lipowska AM, Nicodème F, Teitelbaum EN, Hungness ES, Johnston ER, Gawron A, Kahrilas PJ, Pandolfino JE. Assessing Bolus Retention in Achalasia Using High-Resolution Manometry With Impedance: A Comparator Study With Timed Barium Esophagram. Am J Gastroenterol. 2014;109(6):829-35.

12. Teitelbaum EN, Soper NJ, Pandolfino JE, Kahrilas PJ, Boris L, Nicodème F, Lin Z, Hungness ES. An extended proximal esophageal myotomy is necessary to normalize EGJ distensibility during Heller myotomy for achalasia, but not POEM. Surg Endosc. 2014;28(10):2840-7.

13. Teitelbaum EN, Soper NJ, Santos BF, Rooney DM, Patel P, Nagle AP, Hungness ES. A simulator-based resident curriculum for laparoscopic common exploration. Surgery. 2014;156(4):880-7, 890-3.

14. Teitelbaum EN, Soper NJ, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, Hirano I, Hungness ES. Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for achalasia. Surg Endosc. 2014;28(12):3359-65.

15. Teitelbaum EN, Soper NJ, Pandolfino JE, Kahrilas PJ, Hirano I, Boris L, Nicodème F, Lin Z, Hungness ES. Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes. Surg Endosc. 2014;29(3):522- 8.

16. George BC, Teitelbaum EN, Meyerson S, Schuller MC, DaRosa DA, Petrusa E, Petito L, Fryer JP. Reliability, validity and feasibility of the Zwisch scale for assessment of intra-operative performance. J Surg Educ. 2014;71(6):e90-6.

17. Harmath CB, Horowitz JM, Berggruen SM, Hammond NA, Nikolaidis P, Miller FH, Goodhartz LA, Teitelbaum EN, Hungness ES, Yaghmai V. Fluoroscopic Findings Post Peroral Esophageal Myotomy. Abdom Imaging. 2015;40(2):237-45.

18. Khashab MA, Messallam AA, Onimaru M, Teitelbaum EN, Ujiki MB, Gitelis ME, Modayil RJ, Hungness ES, Stavropoulos SN, El Zein MH, Shiwaku H, Kunda R, Repici A, Minami H, Chiu PW, Ponsky J, Kumbhari V, Saxena P, Maydeo AP, Inoue H. International multicenter experience with peroral endscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy. Gastrointest Endosc. 2015;81(5):1170-7. 19. Teitelbaum EN, Sternbach JM, El Khoury R, Soper NJ, Pandolfino JE, Kahrilas PJ, Lin Z, Hungness ES. The effect of incremental distal gastric myotomy lengths on EGJ distensibility during POEM for achalasia. Surg Endosc. 2015 [Epub ahead of print]

20. Sternbach JM, El Khoury R, Teitelbaum EN, Soper NJ, Pandolfino JE, Hungness EH. Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes. Surgery. 2015 [Epub ahead of print]

C. Prior Research Support

Alvin H. Baum Clinical Simulation Research Grant, Northwestern Memorial Foundation

“Evaluation of a Simulation-Based Mastery Learning Curriculum for Laparoscopic Common Bile Duct Exploration”

Co-Investigator (Principle Investigator: Eric Hungness, MD)

Date of award: July, 2012

$44,072

Alvin H. Baum Clinical Simulation Research Grant, Northwestern Memorial Foundation

“A Team Training Curriculum for Laparoscopic Common Bile Duct Exploration”

Co-Investigator (Principle Investigator: Eric Hungness, MD)

Date of award: September, 2013

$42,271

BRIEF BIOGRAPHICAL SUMMARY Provide the following information for personnel in the order listed on the Budget sheet. Photocopy this page for each person.

Name Position Title Reavis, Kevin M. Foregut Surgery

Education/Training (Begin with baccalaureate or other initial professional education, and include postdoctoral training.) Institution and Location Degree Year Field of Study

University of Virginia BA 1991-1995 Biochemistry Vanderbilt University School of Medicine MD 1995-1999 Medicine Oregon Health & Science University Intern 1999-2000 GeneralSurgery Oregon Health & Science University Resident 2000-2006 General Surgery Oregon Health & Science University/ Portland Research 2002-2004 Foregut Surgery . Veterans Affairs Medical Center Fellowship . General Surgery Oregon Health & Science University Sr/Chief Resident 2004-2006 Minimally Invasive The Ohio State University Medical Center Fellowship 2006-2007 Surgery RESEARCH AND PROFESSIONAL EXPERIENCE: Concluding with present position, list, in chronological order, previous employment, experience, and honors. List in chronological order, the titles, all authors and complete references to all publications during the past three years and to representative earlier publications pertinent to this application. If the list of publications in the past three years exceeds two pages, select the most pertinent publications. DO NOT EXCEED TWO PAGES. Employment

1993-1995 University of Virginia, Organic chemistry laboratory, teaching assistant 1996 Minority Medical Education Program, United Negro College Fund, Pre-medical Summer Institute Fisk University and Vanderbilt University, Problem Based Learning, instructor

1996 Vanderbilt University School of Medicine, Department of Otolaryngology, research student involving botulinum A toxin in treatment of spasmotic dysphonia

1997 Surgical Oncology, St. Thomas Hospital, Nashville TN, student surgical fellow with Richard Geer MD

2006-2007 Clinical Assistant Professor of Surgery, The Ohio State University Medical Center

2007-2011 Assistant Professor of Clinical Surgery, University of California, Irvine Medical Center/ Long Beach VA Healthcare System

2011-Present Foregut Surgeon/ Affiliate Assistant Professor of Surgery, The Oregon Clinic/ Oregon Health & Science University

Experience 2010-present Instructor, Biology 199: Thomas Vo, 3rd year undergraduate student; independent surgical research program, University of California, Irvine Medical Center 2010 Lab Faculty, The Queen’s Medical Center Minimally Invasive Surgery Symposium, Honolulu, HI 2010 Director, Post Graduate Course equipment, SAGES, Washington DC 2010 Co-Director ASMBS Bariatric Skills Acquisition Center, ASMBS, Las Vegas NV

2010 Lab Director, Single Site Surgery and Flexible Endoscopy Course, ASMBS, Las Vegas NV 2010 Faculty Director, Incisionless Surgical GERD, EsophyX Training Course, San Carlos, CA 2010 Member/Faculty, SAGES Leadership, Strategic Planning Summit, Philadelphia PA

2010 Lab Director, Flexible Endoscopy Course, ASMBS 1st Annual Fall Event, Coral Gables, FL 2011 Faculty , Minimizing Minimally Invasive Surgery, Post Graduate Course Lab, Society of American Gastrointestinal & Endoscopic Surgeons, San Antonio, TX 2011 Co-director, Bariatric, Post Graduate Course and Lab, Society of American Gastrointestinal & Endoscopic Surgeons, San Antonio, TX 2011 Co-director, Career Development Seminar, Society of American Gastrointestinal & Endoscopic Surgeons, San Antonio, TX

Honors

2004 First Place, Oregon Health & Science University School of Medicine, Alumni Association Resident Paper Competition

2005 Presidential Citation for excellence in leadership, Oregon Medical Association

2005 Alpha Omega Alpha, Honor Society

2007 SAGES Traveling Fellowship Award, Institut de Recherche contre les Cancers de l'Appareil Digestif/ European Institute of Tele-Surgery. Strasbourg France

2008 Award for Excellence in Patient Directed Care, Long Beach VA Medical Center

2010 Young Surgeon Travel Stipend; $2,000; American College of Surgeons, Southern California chapter, Santa Barbara, CA

Publications

1. Reavis KM, Morris C, Gopal DV, Davis JJ, Hunter JG, Jobe BA. Laryngopharyngeal Reflux Symptoms Better Predict the Presence of Esophageal Adenocarcinoma than Typical Gastroesophageal Reflux Symptoms. Annals of Surgery 2004 239 (6) pp.849-56; discussion 856-8

2. Jobe BA, Reavis KM, Davis JJ, Hunter JG. Laparoscopic Inversion Esophagectomy: Simplifying a Daunting Operation. Diseases of the Esophagus 2004 Vol. 17 (1) pp. 95-97

3. Reavis KM, Chang EY, Hunter JG, Jobe BA. Utilization of the Delay Phenomenon Improves Blood Flow and Reduces Collagen Deposition in Esophagogastric Anastomoses. Ann Surg 2005 241 (5) pp.736-747.

4. Reavis KM, Renton DR, Melvin WS. Robotic Telesurgery for Achalasia. Journal of Robotic Surgery 2007 (1) pp.25-30. 5. Hazey JW, Narula VK, Renton DB, Reavis KM, Paul CM, Hinshaw KE, Muscarella P, Ellison EC, Melvin WS. Natural-orifice transgastric endoscopic peritoneoscopy in humans: Initial clinical trial. Surg Endosc 2008 Jan;22(1):16-20.

6. Reavis KM, Melvin WS. Advanced Endoscopic Technologies. Surg Endosc 2008 Jun;22(6):1533- 46.

7. Varela E, Reavis KM, Hinojosa MW, Nguyen N. Laparoscopic gastric ischemic conditioning prior to esophagogastrectomy: technique and review. Surg Innov. 2008 Jun;15(2):132-5.

8. Nguyen NT, Reavis KM, El-Badawi K, Hinojosa MW, Smith BR. Minimally invasive surgical enucleation or esophagogastrectomy for benign tumor of the esophagus. Surg Innov. 2008 Jun;15(2):120-5.

9. Reavis KM, Hinojosa MW, Smith BR, Nguyen NT. Single-Laparoscopic Incision Transabdominal Surgery . Obes Surg. 2008 Aug 10.

10. Nguyen NT, Reavis KM, Hinojosa MW, Smith BR, Wilson SE. Laparoscopic Transumbilical Cholecystectomy Without Visible Abdominal Scars. J Gastrointest Surg. 2008 Aug 15.

11. Nguyen TN, Hinojosa MW, Smith BR, Gray J, Reavis KM. Thoracoscopic construction of an intrathoracic esophagogastric anastomosis using a circular stapler: transoral placement of the anvil. Ann Thorac Surg. 2008 Sep;86(3):989-92.

12. Smith BR, Hinojosa MW, Reavis KM, Nguyen NT. Outcomes of Esophagectomy According to Surgeon's Training: General vs. Thoracic. J Gastrointest Surg. J Gastrointest Surg. 2008 Nov;12(11):1907-11. Epub 2008 Sep 3.

13. Nguyen NT, Hinojosa MW, Smith BR, Reavis KM. Single Laparoscopic Incision Transabdominal (SLIT) Surgery-Adjustable Gastric Banding: A Novel Minimally Invasive Surgical Approach. Obes Surg. 2008 Dec;18(12):1628-31. Epub 2008 Oct 2.

14. Nguyen NT, Reavis KM, Hinojosa MW, Smith BR, Wilson SE. Laparoscopic transumbilical sleeve gastrectomy without visible abdominal scars. Surg Obes Relat Dis. 2009 Mar-Apr;5(2):275-7. Epub 2008 Jul 18. 15. Narula VK, Happel LC, Volt K, Bergman S, Roland JC, Dettorre R, Renton DB, Reavis KM, Needleman BJ, Mikami DJ, Ellison EC, Melvin WS, Hazey JW. Transgastric endoscopic peritoneoscopy does not require decontamination of the in humans. Surg Endosc. 2008 Oct 15. [Epub ahead of print] 16. Reavis KM, Smith BR, Hinojosa MW, Nguyen NT. Outcomes Of Esophagectomy at Academic Centers: An Association Between Volume And Outcome. Am Surg. 2008 Oct;74(10):939-43. 17. Smith BR, Hinojosa MW, Reavis KM, Nguyen NT. Remission of diabetes after laparoscopic gastric bypass. Am Surg. 2008 Oct;74(10):948-52. 18. Reavis KM, Hinojosa MW, Smith BR, Nguyen NT. Treatment of chronic obstruction as late complication of . Surg Obes Relat Dis. 2008 Nov-Dec;4(6):770-2. Epub 2008 Aug 13. 19. Nguyen NT, Reavis KM, Hinojosa MW, Smith BR, Stamos MJ. A single-port technique for laparoscopic extended stapled appendectomy. Surg Innov. 2009 Mar;16(1):78-81. Epub 2009 Jan 13. 20. Nguyen NT, Slone J, Reavis KM, Woolridge J, Smith BR, Chang K. Laparoscopic transumbilical gastrojejunostomy: an advanced anastomotic procedure performed through a single site. J Laparoendosc Adv Surg Tech A. 2009 Apr;19(2):199-201. 21. Reavis KM. The Esophageal Anastomosis: How Improving Blood Supply Affects Leak Rate. J Gastrointest Surg. 2009 Sep;13(9):1558-60. Epub 2009 May 5. 22. Hinojosa MW, Mailey BA, Smith BR, Reavis KM, Nguyen NT. Minimally invasive Ivor-Lewis esophagogastrectomy for gastric cardia cancer. Surg Endosc. 2009 May 19. 23. Nguyen NT, Slone J, Wooldridge J, Smith BR, Reavis KM, Hoyt D. Minimally invasive esophagectomy without the use of postoperative nasogastric tube decompression. Am Surg. 2009 Oct;75(10):929-31. 24. Reavis KM, Hinojosa MW, Smith BR, Wooldridge JB, Krishnan S, Nguyen NT. Hospital Volume is Not a Predictor of Outcomes after Gastrectomy for Neoplasm. Am Surg. 2009 Oct;75(10):932-6. 25. Nguyen NT, Slone J, Reavis K.Comparison study of conventional laparoscopic gastric banding versus laparoendoscopic single site gastric banding. Surg Obes Relat Dis. 2009 Nov 10. 26. Modak C, Mouazzen W, Narvaez R, Reavis KM, Chai J. CCN1 is critical for acid-induced esophageal epithelial cell transformation. Biochem Biophys Res Commun. 2010 Jan 25. 27. Chai J, Norng M, Modak C, Reavis KM, Mouazzen W, Pham J. CCN1 induces a reversible epithelial-mesenchymal transition in gastric epithelial cells. Lab Invest. 2010 Aug;90(8):1140-51. Epub 2010 May 10. 28. Bergman S, Fix DJ, Volt K, Roland JC, Happel L, Reavis KM, Cios TJ, Ho V, Evans A, Narula VK, Hazey JW, Melvin WS. Do gastrotomies require repair after endoscopic transgastric peritoneoscopy? A controlled study. Gastrointest Endosc. 2010 May;71(6):1013-7. 29. Nguyen NT, Nguyen NT, Dholakia C, Nguyen XM, Reavis K. Outcomes of minimally invasive esophagectomy without pyloroplasty: analysis of 109 cases. Am Surg. 2010 Oct;76(10):1135-8. 30. Dholakia C, Reavis KM. Component separation in the treatment of incisional hernias. J Long Term Eff Med Implants. 2010;20(2):129-32. 31. Tung VS, Buchberg B, Masoomi H, Reavis K, Nguyen NT, Mills S, Stamos MJ. No Visible Scar (NVIS) : A New Approach to Minimal Access Surgery to the Colon. Surg Innov. 2011 Mar;18(1):79-85. Epub 2010 Dec 27. 32. Reavis KM. Management of the obese patient with gastroesophageal reflux disease. Thorac Surg Clin. 2011 Nov;21(4):489-98. Epub 2011 Sep 16. 33. Masoomi H, Kim H, Reavis KM, Mills S, Stamos MJ, Nguyen NT. Analysis of factors predictive of leak in laparoscopic and open gastric bypass. Arch Surg. 2011 Sep;146(9):1048-51.

Research Support

Gerlinger Foundation Research Grant $10,000, March 2003

2008-present Phase IV Study of the AirSeal Access System for Laparoscopic Surgery; participating center- local principal investigator, industry support

2010-present Randomized EsophyX Versus Sham/ Placebo Controlled TIF Trial: The RESPECT Study; participating center- local principal investigator, industry support

BRIEF BIOGRAPHICAL SUMMARY Provide the following information for personnel in the order listed on the Budget sheet. Photocopy this page for each person.

Name Position Title Dunst, Christy M. Director of Research & Education, The Oregon Clinic, Division of GI& Minimally Invasive Surgery

Education/Training (Begin with baccalaureate or other initial professional education, and include postdoctoral training.) Institution and Location Degree Year Field of Study

University of Colorado BA 1989-1993 Molecular Biology University of Colorado BA 1989-1993 Psychology University of Colorado BA minor 1989-1993 Biochemistry University of Colorado Health Sciences MD 1994-1998 Medicine Hennepin County Medical Center Residency 1998-2004 General Surgery University of Southern California Fellowship 2004-2006 Esophageal Surgery Employment

General & Esophageal Surgeon, The Oregon Clinic: GI/MIS 2006-present

Director, Research and Education The Oregon Clinic: GI/MIS 2006-present

Affiliate Associate Professor of Surgery, OHSU 2006-present

Co-Director, Oregon Esophageal Disorders Laboratory 2008-present

Board of Directors; Foundation for Surgical Innovation & Education 2010-present

Teaching Faculty Maracopa Medical Center, Department of Surgery 2011-present

Experience Teaching Assistant 1993 Advanced Neurobiology Laboratory University of Colorado, Boulder Head Teaching Assistant 1995 Introduction to Medical Sciences Summer Course University of Colorado Health Sciences Center Surgical Student Interest Group 2004-2005 Research Mentor and Principle Investigator University of Southern California Keck School of Medicine Clinical Instructor 2005-2006 Division of Thoracic Foregut Surgery Department of Surgery University of Southern California Keck School of Medicine Clinical Assistant Professor of Surgery 2006-present Oregon Health Sciences University Portland, OR Course Faculty 2007-2010 Annual Basic Course Legacy Health System Portland, Oregon Course Faculty 2007-present Annual Postgraduate Course in Advanced Laparoscopy, Surgical Endoscopy and NOTES Portland, Oregon Course Faculty 2011 2011 SAGES Scientific Session & Postgraduate Course San Antonio Convention Center, San Antonio, TX Honors Cancer Student Fellowship Award 1991 Colorado Cancer Center University of Colorado Health Sciences Center Howard Hughes Undergraduate 1993 Research Award University of Colorado, Boulder Alpha epsilon Delta Premedical Honor Society Member 1993 magna cum laude 1993 Department of Molecular, Cellular Developmental Biology University of Colorado, Boulder Resident Teacher of the Year 2001 University of Minnesota Resident Trauma Paper Competition 2002 Third Place Committee on Trauma, State of Minnesota American College of Surgeons Portland’s Best Doctors 2011 Portland Monthly Magazine

Publications

1. Dunst, CM, DeMeester, SR, Desai, U, Hagen, JA, DeMeester, TR. Personal Impact of Abdominal Cramping and Bloating after Laparoscopic . 2005 supplement to Gastroenterology, abstract April 2005 2. Dunst, CM, DeMeester, SR, Desai, U, Hagen, JA, DeMeester, TR. The Evolution, Duration and Personal Impact of Flatulence After Nissen Fundoplication. 2005 supplement to Gastroenterology, abstract April 2005 3. Oh, DS, Hagen, JA, Fein, M, Dunst, C, Bremner, CG, DeMeester, SR, Lipham, J, DeMeester, TR. The Impact of Reflux Composition on Mucosal Injury and Esophageal Function. J Gastrointest Surg. 2006 Jun;10(6):787-96; discussion 796-7. 4. Oh, DS, Hagen, JA, Dunst, CM, DeMeester, SR, Alavi, M, Chandrasoma, PT, Bremner, CG, Lipham, J, Cote, R, DeMeester, TR. The Clinical Biology and Surgical Therapy of Intramucosal Adenocarcinoma of the Esophagus. Journal of the American College of Surgeons 203(2): 152-61 2006. 5. Kuramochi H, Tanaka, K, Oh D, Lehman B, Dunst CM, Yun Yang D, DeMeester SR, Hagen JA, Danenberg K, DeMeester TR, Danenber P. Thymidylate Synthase Polymorphisms and mRNA Expression are Independent Chemotherapy Predictive Markers in Esophageal Adenocarcinoma Patients. Int J Oncol. 2008 Jan;32(1):201-8. 6. Oh DS, DeMeester SR, Mori R, Dunst CM, Lehman B, Kuramochi H, Danenberg K, Danenberg P, Hagen JA, Kirkman E, Kirkman P, Chandrasoma, P, DeMeester TR, Validation of a Rodent Model of Barrett’s Esophagus using Quantitative Gene Expression Profiling. Surg Endosc. 2009 Jun;23(6):1346.52 7. Diwan T, Ujiki M, Dunst CM, Swanstrom LL, Biomesh Placement in Laparoscopic Repair of Paraesophageal Hernias, Surgical Innovation 2008 September: 15(3) 184-187. 8. Khajanchee YS, Ujiki, M, Dunst CM; Swanstrom LL, Patient factors predictive of 24-hour pH normalization following endoluminal gastroplication for GERD. Surgical Endoscopy May 2009 9. Ujiki MB, Martinec DV, Diwan TS, Denk PM, Dunst CM, Swanström LL. Natural orifice translumenal endoscopic surgery (NOTES): creation of a gastric valve for safe and effective transgastric surgery in humans. Surg Endosc. 2009 Jun 17. 10. Spaun GO, Zheng B, Martinec DV, Cassera MA, Dunst CM, Swanström LL. Bimanual coordination in natural orifice transluminal endoscopic surgery: comparing the conventional dual-channel endoscope, the R-Scope, and a novel direct-drive system. Gastrointest Endosc. 2009 May;69(6):e39-45. 11. Cassera MA, Zheng B, Martinec DV, Dunst CM, Swanström LL. Surgical time independently affected by surgical team size. Am J Surg. 2009 Mar 11. 12. Diwan TS, Martinec DV, Ujiki MB, Dunst CM, Swanström LL. A simplified technique for placement of biologic mesh in paraesophageal hernia repair (PEH). Surg Endosc 2009 Jun 11. 13. Khajanchee YS, Dunst CM, Swanstrom LL.Outcomes of Nissen fundoplication in patients with gastroesophageal reflux disease and delayed gastric emptying.Arch Surg. 2009 Sep;144(9):823-8. 14. Dunst CM, Swanström LL, Minimally Invasive Esophagectomy. J Gastrointest Surg. 2009 Sep 30. 15. Swanstrom LL, Dunst CM, Spaun GO, Future Applications of Flexible Endoscopy in Esophageal Surgery. J Gastrointest Surg. 2009 Sep 12. 16. Rieder E, Martinec DV, Cassera MA, Goers TA, Dunst CM, Swanstrom LL. A Triangulating Operating Platform Enhances Bimanual Performance and Reduces Surgical Workload in Single-Incision Laparoscopy.J Am Coll Surg. 2010 Dec 28. [Epub ahead of print] 17. Spaun GO, Dunst CM, Arnold BN, Martinec DV, Cassera MA, Swanström LL. Transcervical heller myotomy using flexible endoscopy. J Gastrointest Surg. 2010 Dec;14(12):1902-9. Epub 2010 Aug 19. 18. Spaun GO, Dunst CM, Martinec DV, Arnold BN, Owens M, Swanstrom LL. Mediastinal surgery in connective tissue tunnels using flexible endoscopy. Surg Endosc. 2010 Sep;24(9):2120-7. Epub 2010 Feb 23. 19. Rieder E, Martinec DV, Dunst CM, Swanström LL. A Novel Technique for Natural Orifice Endoscopic Full-Thickness Colon Wall Resection: An Experimental Pilot Study. J Am Coll Surg. 2011 Jun 18. 20. Rieder E, Martinec DV, Dunst CM, Swanström LL. Flexible endoscopic Zenkers diverticulotomy with a novel bipolar forceps: a pilot study and comparison with needleknife dissection. Surg Endosc. 2011 May 2. 21. Arnold BN, Dunst CM, Gill AB, Goers TA, Swanström LL. Postoperative Impedance-pH Testing is Unreliable After Nissen Fundoplication With or Without Giant Hiatal Hernia Repair., J Gastrointest Surg. 2011 Sep;15(9):1506-12. Epub 2011 Jun 30. 22. Hibbard ML, Dunst CM, Swanström LL., Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement., J Gastrointest Surg. 2011 Sep;15(9):1513-9. Epub 2011 Jul 1. 23. Goers TA, Cassera MA, Dunst CM, Swanström LL. Paraesophageal Hernia Repair with Biomesh Does Not Increase Postoperative Dysphagia., J Gastrointest Surg. 2011 24. Goers TA, Leão P, Cassera MA, Dunst CM, Swanström LL., Concomitant Endoscopic Radiofrequency Ablation and Laparoscopic Reflux Operative Results in More Effective and Efficient Treatment of Barrett Esophagus., J Am Coll Surg. 2011 Jul 22.

Research Support

SAGES Research Grant $14,996 2005

Validation of a Rat Model of Barrett’s Esophagus

Co-PI: CM Dunst,PI: Steven R. DeMeester, MD University of Southern California

NOSCAR Research Grant $51,000 2008

The Role of Flexible Endoscopy in Mediastinal Dissection for Esophageal Surgery

Co-PI: CM Dunst, MD & GO Spaun, MD Legacy Health System, Portland Oregon

Legacy RAC Research Grant $16,500 2008

Mediastinal Surgery with Flexible Endoscopes: A Less Invasive Novel Approach

Co-PI: CM Dunst, MD & GO Spaun, MD Legacy Health System Portland Oregon

Euronotes Foundation Grant $36,000 (EURO) 2008

The Role of Flexible Endoscopy in Mediastinal Dissection for Esophageal Surgery: Comparing Transesophageal and Cervical Flexible Endoscopic Approaches

Co-PI: CM Dunst, MD & GO Spaun, MD Legacy Health System, Portland Oregon

80% clinical 20% research

BIOGRAPHICAL SKETCH Provide the following information for the key personnel and other significant contributors in the order listed on Form Page 2. FollowNAME this format for each person. DO NOT EXCEED FOURPOSITION PAGES. TITLE Lee L. Swanstrom Professor of Surgery, (Clinical) Oregon Health eRA COMMONS USER NAME: LSwanstrom Sciences University Program Director Foregut and Minimally invasive EDUCATION/TRAINING (Begin with baccalaureate or otherSurgery, initial Providence professional Health education, systems, such Portland, as nursing, and include postdoctoral training.) DEGREEOregon INSTITUTION AND LOCATION (if YEAR(s) FIELD OF STUDY applicable) University of Colorado and University of Paris LLD(MA) 1980 Medieval Studies

Creighton University: Omaha, Nebraska M.D. 1980- 1983 Medicine

Emanuel/Kaiser Hospitals Portland, OR Internship 1983-1984 General Surgery

Emanuel/Oregon Health Sciences University Resident 1984-1988 General Surgery Portland, OR

University of Western Ontario, London, Ontario, Fellowship 1994-1995 GI Surgery/Surgical Program Director: Ronald Passi, M.D Endoscopy

A. Positions and Honors 1. SAGES – long standing committee and board member a. Committee chair of 4 committees b. President (2004-2005) c. Foundation Chairman 2. Creator of the FLS program 3. Founding member of the Fellowship Council and 3rd President of same 4. Conceived and Developed the STEP program (flexible endoscopes for surgery resident training programs) 5. Established Minimally Invasive Surgery program in Legacy a. First MIS OR suites in US b. MIS foregut program c. MIS peds surgery program d. MIS Bariatric program e. MIS colorectal program f. MIS Fellowship program: i. 45 postgraduate Fellows trained ii. 89 Residents trained g. MIS research program i. 215 publications ii. 38 peer reviewed grants iii. 13 post doctoral fellows 6. ACS level I accreditation of Legacy training institute (LISEI) 2008 7. Created the Foundation for Surgical Fellowships and secured 14 million dollar commitments 8. Collaborated in the development and submission of IHU-Strasbourg proposal for French National Concours: awarded #1 proposal by the French government (110 million Euros) 2010 9. Founded the Innovations Program at the IHU-Strasbourg (I-SIP) 10. Designed Residency training curriculum for Integrated Image Guided Surgery for the French Residency system (pilot implementation University of Strasbourg 2013) 11. Clinical 1sts: a. 1st regional laparoscopic cholecystectomy b. 1st laparoscopic CBDE c. 1st Lap Nissen in USA d. 1st lap esophagectomy in USA e. 1st laparoscopic Heller myotomy in US f. 1st regional laparoscopic inguinal hernia, adrenal, colon resection, gastric bypass, gastrectomy g. 1st transgastric cholecystectomy h. 1st POEM procedure, France Selected Committee Positions:

American Board of Surgery

- Director - 2014 - 2020 - GI surgery Advisory Committee – 2010 – 2014 - Ad hoc committee for GI surgery certification 2011 - present - Advanced training committee – 2014 - present Society of American Gastrointestinal Endoscopic Surgeons

- Executive Committee -Secretary - 1998 - 2001 - First Vice President - 2001- 2002 - President Elect – 2002 – 2003 - President – 2003 - 2004 - Board Member 1996 – 2010: 2014 – present - State Chairman, 1994 - 1997. - Co-chairman - Continuing Education Committee, 1993 - 1995. - Chairman - Continuing Education Committee, 1996 - 1998. - Resident Education Committee, 1993 - present. - Chairman Poster Presentation Committee, 1994. - Chair: FLS project group, 1998 – 2001 - co-chair: FLS committee 2002 – 2008 - Member, ACS/SAGES FLS Joint Committee – 2006 – present - Chair: Nominating Committee 2004-2005 - Assets Management Committee - 1998 - 2006. - Finance Committee - 1998 - 2007. - Program Committee - 1999 – 2006 - Chair: Awards Committee – 2008 - present - Teaching faculty, SAGES Residency Endoscopy Training - Representative American Board of Surgery - 2014 - 2020 - Courses; Cincinnati, Ohio, Los Angeles, CA. 1994 - Present. - Nominating Committee – 2006 – 2009 - Chair – Awards Committee – 2008 – present - Chair – adhoc committee for Olympus “Flexible Endoscopes for Every Surgeon” (STEP) program – 2008 - present Recent Honors 2009 Distinguished Service Award: SAGES 2013 Commendation, Acadamie National de Chirugie – France 2015 SAGES George Berci Lifetime Achievement Award 2015 Honorary induction as Engineer of Ireland (College of Irish Engineers) B. Selected peer-reviewed publications (Selected as most relevant to current grant from 215 peer-reviewed publications, with 2 book chapters pertinent to subject matter of current grant) 1. Swanstrom LL, Hansen P. “Laparoscopic Total Esophagectomy” Arch Surg, 1997;132(9):943 - 947. 2. Patterson EJ, Herron DM, Hansen PD, Ramzi N, Standage BA, Swanstrom LL “Effect of an esophageal bougie on the incidence of dysphagia following Nissen fundoplication: a prospective blinded randomized trial” Arch Surg, 2000. 135(9):1055-1062.* 3. Horvath KD, Swanstrom LL, Jobe B “The Short Esophagus: Pathophysiology, Incidence, Presentation and Treatment in the Era of Laparoscopic Anti-reflux Surgery” Ann Surg, 2000. 232(5):630-640.* 4. Urbach D, Hansen PD, Khajanchee Y, Swanstrom LL. “A decision analysis of the optimal initial approach to Achalasia: Laparoscopic Heller myotomy with partial fundoplication, Thoracoscopic Heller myotomy, pneumatic dilatation, or Botulinum toxin injection” J Gastrointest Surg, 2001. 5(2): 192-205. 5. Ben-Meir A, Urbach D, Khajanchee YS, Hansen PD, Swanstrom LL. “Quality of life before and after laparoscopic Heller myotomy for achalasia” Am J Surg, 2001. 181(5):471-474. 6. Swanstrom LL. “Management of patients with gastroesophageal reflux disease and esophageal or gastric dysmotility” J Gastrointestinal Surg, 2001. 5(5):448-450.* 7. Khajanchee YS, VanAndel R, Jobe BA, Barra MJ, Swanstrom LL. “Electrical stimulation of the vagus nerve restores motility in an animal model of achalasia” J Gastrointest Surg 2003. 7(7):843-9.* 8. Patterson EJ, Davis DG, Khajanchee Y, Swanstrom LL. “Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn.” Surg Endosc. 2003 17(10):1561-5 9. O’Rourke RW, Khajanchee YS, Urbach DR, Lee NN, Lockhart BA, Hansen PD, Swanstrom LL. “Extended transmediastinal dissection: an alternative to gastroplasty for the short esophagus” Arch Surg 2003 138(7):735-40.* 10. Hong D, Khajanchee YS, Pereira N, Lockhart B, Patterson E, Swanstrom LL. “Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese” Obes Surg. 2004;14(6):744-749. 11. Swanstrom LL “Thoracoscopic/Laparoscopic Esophagectomy” chpt in Atlas of Minimally Invasive Surgery, Jones, Maithel, Schneider, eds. Cine-Med, Inc. Woodbury, CN. 2006: pp 496-523. 12. Rieder E, Martinec DV, Dunst CM, Swanström LL. A Novel Technique for Natural Orifice Endoscopic Full-Thickness Colon Wall Resection: An Experimental Pilot Study. J Am Coll Surg. 2011 Sep;213(3):422-9. 13. Rattner DW, Hawes R, Schwaitzberg S, Kochman M, Swanstrom LL. The Second SAGES/ASGE White Paper on natural orifice transluminal endoscopic surgery: 5 years of progress.Surg Endosc. 2011 Aug;25(8):2441-8 14. Rawlings A, Soper NJ, Oelschlager B, Swanstrom LL, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2011 Jul 26. 15. Rieder E, Dunst CM, Kastenmeier AS, Makris KI, Swanstrom LL. Development and technique of per-oral endoscopic myotomy (POEM) for achalasia. 2011. European Surgery. 43(3):140- 145. doi 10.1007/s10353-011-0017-z. 16. Swanström LL, Rieder E, Dunst CM. A Stepwise Approach and Early Clinical Experience in Peroral Endoscopic Myotomy for the Treatment of Achalasia and Esophageal Motility Disorders. J Am Coll Surg. 2011 Oct 12. 17. Swanstrom LL. Esophagectomy. Chapter 5 in NETTER’S SURGICAL ANATOMY AND APPROACHES edited by Conor P. Delaney, MD, Elsevier, 2012 18. Bhayani NH, Gupta A, Dunst CM, Kurian AA, Halpin VJ, Swanström LL. Does Morbid Obesity Worsen Outcomes After Esophagectomy? Ann Thorac Surg. 2013 May;95(5):1756- 61. B. Research Support (Selected Research Support) 1. Antireflux Surgery Long-term Therapy Database Creation and Maintenance - Ethicon , $ 210,000 – 1994 – 2002. 2. Long Term Outcomes Following Laparoscopic Antireflux Surgery – Ethicon, $208,500, 1995-2001 3. Electromechanical Activity of the Esophagus in an Esophageal Dismotility Model – SAGES, $15,000, 1998 4. Minimally Invasive Surgery Research and Education – Good Samaritan Hospital Foundation, $1.2 Million 1998 5. Establishment of an Animal Model for Esophageal Motor Dysfunction – Legacy Research Advisory Committee Grant, $45,000, 1998 6. Education and Telesurgery Center- Stryker, Inc., $880,000, 1999 7. Minimally Invasive Surgery Program of Excellence – Ethicon Endosurgery, $1.3 Million, 2000 8. New Technology in Surgery, Fellowship – Applied Medical, Inc. $300,000, 2000 9. Study Grant – Randomized Comparison of the Hill and Nissen fundoplication - Hill Foundation, $26.000, 2003- 20010 10. Endoscopic Prevention of Esophageal Anastomotic Leak with Temporary Placement of an Expandable Plastic Stent in Porcine Model – ASGE, $15,000, 2005 11. An evaluation of using fundamental laparoscopic surgery (FLS) program to assess laparoscopic competence for gynecologists – SAGES Education and Research Foundation $15,000, 2005-2007 12. An observational study on the team-related activities performed by the nurse and surgeon during minimally invasive surgery – The Legacy Research Advisory Committee Grant, $10,260 2005-2007 13. Constructive validation studies on using a bench model for laparoscopic team training – The Society of Gastrointestinal and Endoscopic Surgeons (SAGES) Research Grant, $15,000, 2006-2007 14. New technology in Surgery; Fellowship - Applied Medical, Inc. $312.000, 2006 - 2011. 15. Mind Control: The challenges of perception and manipulation in natural orifice surgery – NOSCAR, $61,488, 2007-2008 16. Grant for Investigations in Transenteric Endoscopic Treatments of GI Disease - NOSCAR , $78,000 2007 – 2010. 17. Program Development Grant NOTES Research Medical Research Foundation of Oregon, $110.000, 2007-2011. 18. Transenteric Endoscopic Node Harvest in the Mediastinum - $45,000 European Association of Endoscopic Surgery, 2008 – 2009. 19. An Incisionless Approach for Radical Sigmoid Resection and Primary Anastomosis - NOSCAR, $30,000, 2009-2010. 20. Endoscopic full-thickness colon resection EAES 2010, $25,000 SAGES Participation:

Ahmed Sharata MD,

Oral/Multimedia Presentation

1. Sharata A, Kurian A, Dunst CM, Reavis KM, Swanström LL: Sleeve Endoscopic Esophageal Mucosotomy (SEEM). Plenary Podium Presentation: 16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

2. Robinson B, Sharata A, Dunst CM, Pescarus R, Shlomovtz E, Reavis K, Swanström LL: 20-years later: Laparoscopic fundoplication durability. Plenary Podium Presentation: 16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

3. Pescarus R, Sharata A, Dunst CM, Shlomovtz E, Reavis K, Swanström LL: The nightmare of the GI surgeon – Video. Podium Presentation: 16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

4. Shlomovtz E, Dunst CM, Sharata A, Pescarus R, Reavis K, Swanström LL: Early human experience with Per-Oral Endoscopic (POP). Podium Presentation:16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

5. Shlomovtz E, Dunst CM, Sharata A, Pescarus R, Reavis K, Swanström LL: Endoscopic Per-Oral Pyloromyotomy (POP). Podium Presentation:16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

6. Sharata A, Kurian A, Dunst CM, Bhayani N, Reavis KM, Swanström LL: Contemporary Flexible Endoscopic Management of Acute Esophageal Perforation, Plenary Podium Presentation: 15th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Baltimore, MD, April 17-20, 2013.

Poster Presentation:

1. Pescarus R, Dunst CM, Sharata A, Shlomovtz E, Reavis K, Swanström LL: Outcomes of anti-reflux surgery in GERD patients refractory to maximal medical treatment. 16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

2. Pescarus R, Dunst CM, Sharata A, Shlomovtz E, Reavis K, Swanström LL: Impact of obesity on the morbidity of laparoscopic paraesophageal hernia repair: Analysis using the NSQIP Database. 16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

3. Pescarus R, Shlomovitz E, Sharata A, Cassera M, Reavis KM, Dunst MC, Swanstrom LL: Endoscopic assisted trans-gastric and colorectal full thickness resections are enabled by a novel 5 mm surgical stapler. Poster Emerging Technology: 16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

4. Pescarus R, Cassera M, Shlomovitz E, Sharata A, Reavis KM, Dunst MC, Swanstrom LL. Impact of obesity on the morbidity of laparoscopic paraesophageal hernia repair: Analysis using the NSQIP Database. 16th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Salt Lake City, UT, April 2-5, 2014.

5. Kurian A, Dunst CM, Bhayani N, Sharata A, Reavis KM, Swanström LL: DDEStm Flexible Single Incision Operating Platform Facilitates an Extended Thoracic Lymphadenectomy via a Trans-Hiatal Approach. 14th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, San Diego, CA, March 7-10, 2012.

6. Bhayani N, Aliabadi-Wahle S, Kurian A, Sharata A, Reavis KM, Dunst CM, Swanström LL: The Subxyphoid Approach to Thyroidectomy using the DDES, a Flexible, Articulating, Single-Incision Platform. 14th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, San Diego, CA, March 7-10, 2012.

7. Kurian AA, Sharata A, Dunst CM, Reavis KM, Swanström LL: Burst Pressure of Esophageal Mucosotomy Closure in Per-Oral Endoscopic Myotomy: Running Suture Closure vs Mucosal Clip Closure. 15th World Congress of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Baltimore, MD, April 17-20, 2013.

Paul Colavita MD,

-Member: 2009- Present

-SAGES Hernia Taskforce: 2015-Present

- Faculty in postgraduate Hernia Course at SAGES, 2015

-Colavita PD. Chronic pain after ventral hernia repair. Presented at the Society of American Gastrointestinal and Endoscopic Surgeons, Hernia Postgraduate Course, April 15th, 2015, Nashville, TN.

- First Place Award, 2012 SAGES Residents and Fellows Scientific Session. San Diego, Ca. March 9th, 2012. Awarded for the best oral scientific presentation in the Resident and Fellow Scientific Session at the annual SAGES meeting.

- Colavita PD, Walters AL, Tsirline VB, Lincourt AE, Heniford BT. “Laparoscopic Versus Open Hernia Repair, Results from the Nationwide Inpatient Sample.” Presented at the Society of American Gastrointestinal and Endoscopic Surgeons, March 9th, 2012, San Diego, Ca.

- El Djouzi S, Tsirline VB, Colavita PD, Brokamp A, Walters AL, Stefanidis D, Heniford BT. “Pre-operative endoscopic treatment does not adversely impact laparoscopic myotomy outcomes.” Presented at the Society of American Gastrointestinal and Endoscopic Surgeons, March 9th, 2012, San Diego, Ca.

- Zemlyak AY, Tsirline VB, Colavita PD, Lincourt AE, Heniford BT. “Early Clinical Outcomes of Hernia Repair with Physiomesh.” Poster presentation, Society of American Gastrointestinal and Endoscopic Surgeons, March 7-10th, 2012, San Diego, Ca.

- Zemlyak AY, El-Djouzi S, Colavita PD, Stefanidis D, Heniford BT. “Pneumatic Balloon Dilation Has Limited Effectiveness in Patients after Foregut Surgery.” Poster presentation, Society of American Gastrointestinal and Endoscopic Surgeons, March 7-10th, 2012, San Diego, Ca.

-Zemlyak AY, Colavita PD, Tsirline VB, Heniford BT. “Inguinal Hernia Repair with Biologic Mesh: Early Series Outcomes.” Poster presentation, Society of American Gastrointestinal and Endoscopic Surgeons, March 7-10th, 2012, San Diego, Ca.

- Colavita PD, Studstill ME, Tsirline VB, Heniford BT. “Laparoscopic Repair of a Morgagni Hernia in an Adult.” Presented at the Society of American Gastrointestinal and Endoscopic Surgeons, March 8th, 2012, San Diego, CA.

-Nelson CL, Colavita PD, Belyansky I, Kercher KW. “Laparoscopic Approach and Treatment of Celiac Artery Syndrome.” Presented at the Society of American Gastrointestinal and Endoscopic Surgeons, March 9th, 2012, San Diego, Ca.

-Colavita PD, Martin TR, Sing RF, Stefanidis D, Heniford BT. “Laparoscopic Management of the Failed Nissen Fundoplication.” Presented at the Society of American Gastrointestinal and Endoscopic Surgeons, March 10th, 2012, San Diego, CA.

Lee Swanstrom MD,

- Executive Committee -Secretary - 1998 - 2001 - First Vice President - 2001- 2002 - President Elect – 2002 – 2003 - President – 2003 - 2004 - Board Member 1996 – 2010: 2014 - present - State Chairman, 1994 - 1997. - Co-chairman - Continuing Education Committee, 1993 - 1995. - Chairman - Continuing Education Committee, 1996 - 1998. - Resident Education Committee, 1993 - present. - Chairman Poster Presentation Committee, 1994. - Chair: FLS project group, 1998 – 2001 - co-chair: FLS committee 2002 – 2008 - Member, ACS/SAGES FLS Joint Committee – 2006 – present - Chair: Nominating Committee 2004-2005 - Assets Management Committee - 1998 - 2006. - Finance Committee - 1998 - 2007. - Program Committee - 1999 – 2006 - Chair: Awards Committee – 2008 - present - Teaching faculty, SAGES Residency Endoscopy Training - Representative American Board of Surgery - 2014 - 2020 - Courses; Cincinnati, Ohio, Los Angeles, CA. 1994 - Present. - Nominating Committee – 2006 – 2009 - Chair – Awards Committee – 2008 – present - Chair – adhoc committee for Olympus “Flexible Endoscopes for Every Surgeon” (STEP) program – 2008 present

Kevin Reavis MD,

2010 - Director, Post Graduate Course equipment, SAGES, Washington DC

2011 - Faculty , Minimizing Minimally Invasive Surgery, Post Graduate Course Lab, Society of American Gastrointestinal & Endoscopic Surgeons, San Antonio, TX

2011 - Co-director, Bariatric, Post Graduate Course and Lab, Society of American Gastrointestinal & Endoscopic Surgeons, San Antonio, TX

2011 - Co-director, Career Development Seminar, Society of American Gastrointestinal & Endoscopic Surgeons, San Antonio, TX

2007 - SAGES Traveling Fellowship Award, Institut de Recherche contre les Cancers de l'Appareil Digestif/ European Institute of Tele-Surgery. Strasbourg France

Christy Dunst MD,

2005 - SAGES Research Grant $14,996

Validation of a Rat Model of Barrett’s Esophagus

Co-PI: CM Dunst,PI: Steven R. DeMeester, MD University of Southern California

2011 - Dunst CM, Paraesophageal Hernia: Should it be repaired and if so how? Foregut Postgraduate Course SAGES.

2011 - Dunst CM, GERD: Working the Patient Up: How Much is Needed and Who Should Do it? General GERD Session SAGES April 2011

2013 - Dunst CM, PPIs are Better than Antireflux Surgery for GERD, SAGES Foregut Session, SAGES Annual Meeting, Baltimore Maryland

2014 - Dunst, CM & DeMeester SR, POEM Debate SAGES Per-Oral Endoscopic Myotomy Session, SAGES Annual Meeting Salt Lake City, UT.

2014 - Dunst CM, Prevention and Treatment of ESD Strictures, SAGES ESD Session, SAGES Annual Meeting Salt Lake City, UT 2015 - Dunst CM, Esophagus: pH testing, Esophageal Manometry, Heller Myotomy and POEM, SAGES Go-Global webinar to Haiti.

2015 - Dunst CM, Technical Problems: Achalasia Procedures, SAGES Advances in Foregut Surgery PG course, SAGES Annual Meeting, Nashville, TN.