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

GASTROENTEROLOGY AND GI SURGERY

2014 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

Creative Direction: Ideas On Purpose, www.ideasonpurpose.com Design: Craig Williams 29 Leadership Produced by: Office of Communications and Marketing, NYU Langone NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 1

MESSAGE FROM LEADERSHIP

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 H. LEON PACHTER, MD 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 George David Stewart Professor of Surgery states—including obesity, inflammatory bowel disease, colorectal cancer, and Chair of the Department of Surgery pancreatic cancer— to reveal mechanisms and markers that can be targeted NYU Langone Medical Center 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, MARK B. POCHAPIN, MD regional, and national community-based organizations. With these developments, our care quality measures have been enhanced, Sholtz/Leeds Professor of Gastroenterology including lower risk-adjusted mortality and length of stay than any of the New Professor of Medicine York institutions rated by the University HealthSystem Consortium (UHC®). We Director of the Division of Gastroenterology are proud that the multidisciplinary care provided by our gastroenterologists, NYU Langone Medical Center 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. PAGE 2 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

FACTS & FIGURES*

Gastroenterology & GI Surgery

4

NYU Langone was among THE FIRST INSTITUTIONS in the United States to offer:

Full-spectrum endoscopy

Cuff-assisted colonoscopy Colon capsule endoscopy

3D, high-resolution esophageal manometry 20,000 53% 144 of SURGICAL RESIDENTS GASTROENTEROLOGISTS ENDOSCOPY & HEPATOLOGISTS PROCEDURES perform CLINICAL or BASIC including

ANNUALLY SCIENCE RESEARCH SALARIED & VOLUNTARY FACULTY

12 93% GASTROENTEROLOGY of Graduating Surgical Residents & HEPATOLOGY GO INTO FELLOWSHIPS

PRACTICE LOCATIONS

60+ >50% active clinical trials are under way in OF GASTROENTEROLOGY FELLOWS over the last seven years are now in GASTROINTESTINAL DISEASE, ADVANCED FELLOWSHIPS LIVER DISEASE, AND or ACADEMIC PRACTICE LIVER TRANSPLANT

*Numbers represent FY14 (Sept 2013-Aug 2014) unless otherwise noted NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 3

NYU Langone Medical Center

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

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

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

Magnet Designation for Third Consecutive Term for 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. PAGE 4 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

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 and pancreas microbiota, and their possible role in Institutes of Health (NIH) $1,250,000 R01 grant for a pancreatic cancer. study of “Toll-like Receptor Regulation of Pancreatic Tumor Genesis.” Postulating that ligation of toll-like Exploring the gut microbiome and pancreatic cancer. receptors within the inflammatory tumor stroma drives Dr. Miller is co-investigator of research funded by an both stromal advancement and epithelial mutagenesis $840,000 Lustgarten Foundation grant to study the role via novel signaling mechanisms, the research protocol of the gut microbiome in the development of pancreatic is designed to reveal whether blockading toll-like carcinogenesis. receptors is a promising approach to experimental therapeutics in pancreatic cancer.

APPOINTMENT Necroptosis as a central mechanism governing pancreatic cancer cell demise? Funded by a $200,000 Laparoscopic GI Surgeon 2014 Pancreatic Cancer Action Network-AACR Innovative Grant, Dr. Miller is also investigating Specialist Joins NYU Langone whether necroptosis is a central mechanism governing pancreatic cancer cellular demise. The research is NYU Langone named Paresh C. Shah, MD, chief intended to advance the understanding of pancreatic of the Division of General Surgery and vice chair of quality cancer cell biology and related development of novel and innovation in surgery. He specializes in laparoscopic therapeutics. Whipple surgery for pancreatic cancer, other GI resections, and therapeutic endoscopy techniques such as per-oral Pioneering study of the oral microbiome and related endoscopic myotomy (POEM) and endoscopic submucosal pancreatic cancer risk. Dr. Miller is the co-investigator dissection (ESD). Dr. Shah is recognized internationally as on a $90,000 National Cancer Institute R01 grant for a a leader in minimally invasive surgery and gastrointestinal “Prospective Study of Oral Microbiome in Pancreatic disease. Dr. Shah serves on the board of governors of the Cancer.” The research will investigate the latest genomic Society of American Gastrointestinal and Endoscopic microbiome and transcriptome assays for assessing oral Surgeons and on the editorial review boards of Surgical Endoscopy, Journal of the American College of Surgeons, and Surgery of Obesity & Related Diseases. NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 5

EDUCATION Gastroenterology Fellowship Potential New Funding for Program Produces IBD iBook Research Training for GI Oncology With support from an American Gastroenterological Association education grant, Sophie M. Balzora, MD, NYU Langone has received highly favorable scores assistant professor of medicine; Lisa Malter, MD, on a recent grant application to fund “Research Training assistant professor of medicine; and Martin Wolff, MD, for Physician-Scientists in Gastrointestinal Oncology” senior gastroenterology fellow, developed the new iBook, from the NIH. NYU Langone Gastroenterology Fellowship Training Program Pocket Guide: Key Concepts in Managing Patients with Inflammatory Bowel Disease (IBD). Gastrointestinal Oncology The new resource is designed to be used on iPads or Research Fellowship Program smart-phones in the management of Crohn’s disease and ulcerative colitis. The changing landscape of among First in the Country therapeutics makes treating patients with IBD complex, so it’s increasingly important for gastroenterology The new Bernard and Irene Schwartz Gastrointestinal fellows to understand the complete care of IBD patients. Oncology Fellowship Program, launched in 2014, will The “pocket guide” was created to supplement be among the first in the country dedicated to training gastroenterology fellowship education by providing physician-scientists in gastrointestinal cancer research. a comprehensive, case-based, quick reference to Focus areas will include the pancreatic cancer tumor managing IBD. The iBook was created in collaboration microenvironment, the molecular basis of cancer with the NYU School of Medicine Institute for development, bacteria and viruses that influence cancer Innovations in Medical Education. The iBook can be development, and gastrointestinal inflammation that downloaded at iTunes, https://itunes.apple.com/us/ can lead to cancer. book/key-concepts-in-managing-patients/ id915394601?mt=11.

EXPANSION OUTREACH Gift Propels Growth of Providing Evidence for the Cancer Center Adverse Effects of Antibiotics

Benjamin G. Neel, MD, PhD, assumed the directorship Missing Microbes: How the Overuse of Antibiotics of the Laura and Isaac Perlmutter Cancer Center (formerly Is Fueling Our Modern Plagues by Martin Blaser, MD, NYU Cancer Institute) in January 2014. A world-renowned was published in 2014 and was favorably reviewed by cancer biologist, Dr. Neel previously directed the Toronto- The New York Times. The book provides evidence for the based Ontario Cancer Institute, Canada’s largest cancer adverse effects of antibiotics, and tells what can be done research center. The Perlmutter Cancer Center is poised for to avoid catastrophic health problems in the future. Dr. growth following a gift in excess of $50 million from the Blaser is the Muriel G. and George W. Singer Professor Laura and Isaac Perlmutter Foundation to advance cancer of Translational Medicine and director of the Human research and treatment at NYU Langone. Microbiome Program. PAGE 6 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

NEW & NOTEWORTHY

OUTREACH

Engaging with the Media to questions from participants about the importance of Promote Colon Cancer colon cancer screening recommendations and options. As a frequent contributor to Fox News, Today, Screening CNN, and ABC News, Roshini Rajapaksa, MD, associate professor of medicine, is also spreading the word about According to the American Cancer Society, colon the importance of colon cancer screening. She specializes cancer incidence has decreased by 30 percent over the in women’s health issues and has published several last decade in large part due to an increase in colon studies related to colon cancer screening. 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 PARAESOPHAGEAL HERNIAS NYU Langone and funded by a New York Society for Gastrointestinal Endoscopy Florence Lefcourt Award Repairing 100 Percent of designed to dispel misperceptions about colon cancer Paraesophageal and Hiatal and encourage screening. Using engaging graphics and easy-to-follow narration, the video is the newest tool in Hernias Laparoscopically NYU Langone’s robust community outreach program, and can be viewed on YouTube. All repair of paraesophageal and hiatal hernias is In another novel approach to community education performed laparoscopically at NYU Langone, helping and outreach, Jonathan LaPook, MD, the Mebane to reduce length of stay and improve patient experience. Professor of Gastroenterology and CBS News chief Paraesophageal hernias are on the rise, and NYU medical correspondent, hosted a Google+ Hangout Langone is also a high-volume center, performing with Mark B. Pochapin, MD, the Sholtz/Leeds Professor close to 50 repairs a year. of Gastroenterology and director of the Division of Gastroenterology, and Gina Mileo, RN. The trio took NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 7

Awards and Recognitions

Dafna Bar-Sagi, PhD, senior vice president, vice dean for Martin J. Blaser, MD, the Muriel G. and George W. Singer science, and chief scientific officer, received a 2014 Pancreatic Professor of Translational Medicine and director of the Cancer Action Network - AACR Innovative Grant to study Human Microbiome Program, received the Pancreatic whether anatomical location in the pancreas can dictate the Cancer Action Network-AACR Innovative Award. course of tumor development. In 70 to 80 percent of cases, pancreatic ductal adenocarcinoma develops in the pancreas Lea Ann Chen, MD, instructor in medicine, was elected vice head and uncinate process regions, leading to speculation chair of the New York Crohn’s and Colitis Organization and about the importance of location in tumor development. serves on the organization’s executive council.

Russell S. Berman, MD, associate professor of surgery, Ilseung Cho, MD, assistant professor of medicine, received won the 2014 Alpha Omega Alpha Alumni Award and was a 2014 Clinical Scientist Development Award from the Doris appointed chairman of the Society of Surgical Oncology Duke Charitable Foundation. The award will support Dr. SCORE Committee. He is also an associate examiner for the Cho’s research into the role of the human microbiome in the American Board of Surgery, associate editor of the Journal of development of colon cancer. He hypothesizes that the the National Cancer Institute, and a member of the National human microbiome may cause hypermethylation of specific Cancer Institute’s PDQ® Adult Treatment Editorial Board. DNA repair genes, impairing the body’s ability to repair damaged cells and leading to precancerous and cancerous Mitchell A. Bernstein, MD, associate professor and director, lesions. Dr. Cho’s previous research revealed possible links colon and rectal surgery, and Harvey G. Moore, MD, assistant between the human microbiome and obesity, and was professor of surgery, are collaborating with principal published in Nature and Cell. investigator Cynthia G. Leichman, MD, to examine the “Gene Methylation Profile of Rectal Cancer and its Predictive Value Donnele Daley, MD, teaching assistant in the Department for Response to Neoadjuvant Chemoradiation Therapy.” of Surgery, received the Schwartz GI Fellowship for her research work under the mentorship of George Miller , MD. Audio-Digest Foundation’s General Surgery Board Review will feature a course on Anal Cancer by Mitchell A. Bernstein, MD. PAGE 8 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

NEW & NOTEWORTHY

George A. Fielding, MD, the J. Ira and Nicki Harris Family editor of the American Society for Gastrointestinal Professor of Surgery and Bariatric Medicine, was named one Endoscopy (ASGE) journal Gastrointestinal Endoscopy. of the 30 most influential members of the American Society He also serves on the ASGE practice management committee, of Metabolic and Bariatric Surgery over the last 30 years. and on the American College of Gastroenterology (ACG) training committee, and educational affairs committee. Fritz François, MD, associate professor of medicine, was He is editor of ACG Universe and is the ACG’s American named recipient of the American College of Gastroenterology’s Board of Internal Medicine liaison. Minority Digestive Health Care Award. The judges cited his active involvement in clinical practice/clinical research and Norman B. Javitt, MD, PhD, professor of medicine and efforts to improve the digestive health of a minority group or pediatrics, won the American Physiological Society’s underserved population. History of Physiology Group 2014 Recognition Award for his presentation, “The History of Hepatic Bile Formation: Adam J. Goodman, MD, assistant professor of medicine Investigator’s Dilemma; Patient’s Problems,” presented and director of endoscopy at Bellevue Hospital Center, at Experimental Biology 2014. has been named vice president of the New York Society for Gastrointestinal Endoscopy. He will become the society’s Seymour Katz, MD, clinical professor of medicine, was president in 2015. named to the New York Crohn’s and Colitis Organization executive council. Seth A. Gross, MD, associate professor of medicine and gastroenterology section chief, was appointed an associate NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 9

Harvey G. Moore, MD, assistant professor of surgery, He also serves on the board of trustees of the American received the “Works in Progress Award” from the American College of Gastroenterology (ACG) and as director and Society of Colon and Rectal Surgeons Research Foundation treasurer of the ACG and American Society for Gastrointestinal for his paper, “Novel Inhibitors of WNT/β-Catenin Endoscopy’s collaborative GIQuIC quality initiative. Responsive Transcription Augment Response of HCT116 CRC Cells to Radiation In Vitro and In Vivo.” He was also Paresh C. Shah, MD, professor of surgery and vice chair named a total mesorectal excision-credentialed surgeon of quality and innovation in surgery, was the recipient of by the Alliance for Clinical Trials in Oncology and serves the Excellence in Medical Leadership Award from the Society on the Fundamentals of Rectal Cancer Surgery Committee of American Gastrointestinal and Endoscopic Surgeons. of the American Society of Colon and Rectal Surgeons. Alejandro Torres-Hernandez, MD, postdoctoral fellow H. Leon Pachter, MD, the George David Stewart Professor under the mentorship of Dr. George Miller, was awarded of Surgery and chair of the Department of Surgery, serves on the “Emerging Liver Scholar Award” from the American the editorial boards of Annals of Surgery and The Journal of Association for the Study of Liver Diseases. Trauma and Critical Care. Lewis W. Teperman, MD, associate professor of surgery, Mark B. Pochapin, MD, the Sholtz/Leeds Professor was named Physician of the Year in 2014 by the American of Gastroenterology and director of the Division of Liver Association Greater New York Division. Gastroenterology, has been reappointed to the steering committee of the National Colorectal Cancer Roundtable. PAGE 10 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

THE HUMAN MICROBIOME

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. NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 11

Cultivating Insights from the Microbiome

THE HUMAN MICROBIOME

One Cause of Obesity May Be Investigating Gut Microbiome Microbiome Alterations Changes in Pediatric Patients with C. difficile Colitis Bacteria living in the human gastrointestinal tract outnumber human cells by a factor of 10—and the According to the to the Centers for Disease Control aggregate genetic information contained within those and Prevention, about 14,000 Americans die each year bacteria is several magnitudes greater than that found from Clostridium difficile, or C. diff, infection. Antibiotics in the host human genome. This emerging field of often can be ineffective in treating this infection, and research is revealing that perturbing our resident fecal microbial transplant has been demonstrated in microbial communities at critical time points can have most studies to date to be more than 90 percent effective damaging—and lasting—consequences. Martin J. Blaser, in treating C. diff cases in patients who do not respond MD, the Muriel G. and George W. Singer Professor of to conventional antibiotic therapies. Translational Medicine and director of the Human In a collaborative effort with the Johns Hopkins Microbiome Program, is leading a research team to School of Medicine, NYU Langone’s Lea Ann Chen, shed new light on how antibiotics can profoundly MD, instructor of medicine, is investigating the gut reshape the microbial communities that live within microbiome of pediatric patients ages 6 to 17 with us and contribute to chronic conditions. C. diff colitis who have failed conventional therapies, According to this research, conducted by Ilseung Cho, observing changes following fecal transplant. Each MD, assistant professor of medicine, these alterations patient serves as his or her own control; researchers in the gut microbiome may be driving certain cases of collect stool samples before and after fecal transplant. obesity. Sub-therapeutic antibiotics are regularly given As a second control, researchers collect stool samples to animals in the agricultural industry to promote from fecal transplant donors (usually an adult growth by allowing feed to be more thoroughly digested family member). and absorbed. Those antibiotics subsequently enter the As she explains, “We’re evaluating the differences food chain and may promote similar effects in humans. between the gut microbiome of healthy donors and There may also be a link between obesity and the children who have recurrent C. diff infections requiring over-prescription of therapeutic antibiotics in humans fecal transplant, to better understand why the transplants for various childhood infections. “We’ve developed a work and why certain patients, such as those with murine model to demonstrate that exposure to low-dose inflammatory bowel disease, are at increased risk antibiotics can permanently change the gut microbiome, for recurrent C. diff infections.” 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. PAGE 12 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

THE HUMAN 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. EVIDENCE SHOWS GUT VIRUSES Revealing the interplay between inflammation and the ALSO PLAY ROLE IN INTESTINAL microbiome in the context of pancreatic cancer will ECOSYSTEM provide novel targets for prevention and treatment.

NYU Langone microbiologists have what may be the first strong evidence that the natural presence of viruses Bacteria living in the human in the gut—or the “virome”—plays a health maintenance and infection- gastrointestinal tract fighting role similar to that of intestinal bacteria. In a series of experiments outnumber human cells by a reported November 19, 2014 in Nature Online, researchers found that infection factor of 10 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. NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 13

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. PAGE 14 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

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. NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 15

Reducing a Preventable Burden

COLON CANCER

Among the First to Offer and Evaluate New Colonoscopy Technologies

Colonoscopy remains a gold standard in colon The camera pill is utilized to capture images from cancer screening, and NYU Langone gastroenterologists the area of the colon that could not be viewed are among the first in the nation to offer the latest during the original colonoscopy procedure. colonoscopy technologies and techniques. “The focus remains always on quality in endoscopy,” says • A non-oral, same-day prep regimen. NYU Mark B. Pochapin, MD, the Sholtz/Leeds Professor Langone offers select patients the option of colonic of Gastroenterology and director of the Division irrigation—a bowel prep technique for patients of Gastroenterology, “along with a positive patient whose co-morbidities contraindicate the use of experience for this life-saving screening.” the oral prep, who cannot tolerate the oral prep regimen, or for whom the oral prep is insufficient • Full-spectrum endoscopy technology. While to allow for effective visualization of the colon. traditional colonoscopy provides a 170-degree view This technique offers a non-oral, same-day prep of the colon, the new full-spectrum endoscopy regimen for patients in need of this option. technology allows for a 330-degree visual field. This new, expanded optical view offers promise • Balloon-assisted colonoscopy. Balloon-assisted in enhancing the endoscopist’s ability to spot colonoscopy is being evaluated for effectiveness potentially hidden polyps and thus increase polyp/ by NYU Langone gastroenterologists. With this adenoma detection rates. technique, the colonoscopy is fitted with an integrated, reusable balloon. Upon reaching the • Endoscopic cuff-assisted colonoscopy. With cecum, the balloon is inflated. As the colonoscope endoscopic cuff-assisted colonoscopy, a soft, flexible is withdrawn, the balloon acts to smooth out folds projection is attached to the end of the colonoscope. on the colon wall. In a recent multicenter tandem During withdrawal, the tiny flexible fingers of the study presented at national and international cuff help grip the colon wall to mechanically flatten conferences, Seth A. Gross, MD, associate professor folds and enhance visualization of potentially of medicine and gastroenterology section chief; hidden polyps. Mark B. Pochapin, MD, the Sholtz/Leeds Professor of Gastroenterology and director of the Division • New FDA-approved colon capsule endoscopy. of Gastroenterology; and colleagues compared NYU Langone gastroenterologists offer the new, balloon-assisted with traditional colonoscopy, Food and Drug Administration (FDA)-approved finding improved polyp and adenoma detection colon capsule endoscopy for the small subgroup of rates with the balloon-assisted technology. patients who undergo an incomplete colonoscopy. PAGE 16 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

CLINICAL CARE

Minimally-invasive gelatinous or liquid than solid. This process is commonly Approaches Preserve Function called carcinomatosis or pseudomyxoma (if more gelatinous). With colorectal and appendiceal cancers, and Shorten Recovery and even appendiceal tumors that are not clearly cancer, this type of spread can be treated by debulking the NYU Langone is at the forefront of minimally tumor strips or masses through cytoreductive surgery invasive surgery (including the TAMIS transanal followed by direct installation of heated chemotherapy minimally invasive technique), with the vast majority (hyperthermic intraperitoneal chemotherapy, or HIPEC) of colorectal surgeries performed laparoscopically into the abdominal cavity during surgery. This approach compared to approximately 20 percent nationally. NYU may also be an option for other types of cancers. By Langone was the first medical center in New York City to delivering chemotherapy directly, HIPEC enables perform colorectal surgery robotically over a decade ago. drug-to-tumor contact, increases efficacy, allows for a Experts at the Robotic Surgery Center are international much higher chemotherapy concentration than would leaders in performing a wide range of minimally be possible with intravenous therapy, and minimizes invasive procedures with robotic assistance. “The robot side effects, notes Russell S. Berman, MD, associate can be helpful particularly with colorectal cancer professor of surgery. situated in the lower rectum,” explains Elliot Newman, MD, professor of surgery, “where the robot’s precision and maneuverability help preserve normal bowel Promoting Colon Cancer function and can avoid the need for permanent colostomy.” Surgeons perform more than 1,600 robot- Screening in the African assisted surgeries each year in dedicated operating American Community rooms using one of five state-of-the-art surgical systems that include advanced infrared imaging, dual consoles, Focusing on barriers to care in the African American and the latest da Vinci® Si and Xi surgical systems. community, particularly in relation to increasing colon NYU Langone gastroenterologists also use minimally cancer screening, Joseph Ravenell, MD, assistant invasive colonoscopic techniques, including endoscopic professor of medicine, has identified intrinsic and mucosal resection (EMR) and endoscopic submucosal extrinsic barriers to health and primary healthcare use dissection (ESD) to remove large polyps and early-stage among African Americans in a low-income, urban area. cancer of the rectum without a major operation. “Within Expanding on community-based research models that the context of personalized patient care,” says Dr. Dr. Ravenell and Olugbenga G. Ogedegbe, MD, professor Newman, “NYU Langone offers a full range of minimally of population health and medicine and director of NYU invasive surgical and endoscopic procedures for Langone’s Center for Healthful Behavior Change, colorectal cancer when they are appropriate and may developed around hypertension, Dr. Ravenell is leading result in faster recovery and reduced length of stay.” National Institutes of Health (NIH)-funded research utilizing a faith-based approach to colon cancer screening in the New York City African American Hyperthermic Intraperitoneal community. As part of this cluster-randomized controlled trial, Dr. Ravenell’s team has provided Chemotherapy (HIPEC) Plus educational interventions about colorectal cancer in 89 Cytoreductive Surgery churches and mosques, reaching nearly 3,380 black men age 50 and older and enrolling 451 participants in the Applied to Colorectal Tumors study. Additionally, they have trained over 100 lay health workers at these churches to deliver colorectal cancer NYU Langone has an active program to treat screening information to their congregations. The peritoneal surface malignancy. Under certain researchers hope this program will serve as a new model circumstances, gastrointestinal tract malignancies for evidence-based education/outreach and linking and other types of tumors can spread along the linings faith-based settings to the healthcare system, thereby of the intra-abdominal organs and the inner lining of increasing colon cancer screening in African American the abdominal wall itself. Sometimes, this is more men nationwide. NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 17

80%-90% of colorectal surgeries at NYU Langone are performed robotically and laparoscopically, compared to approximately 20 percent nationally

MULTIDISCIPLINARY PATIENT CASE CONFERENCE FOR COMPLEX GI CANCERS

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. PAGE 18 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

CLINICAL CARE

New Hope for Those at Risk

LIVER DISEASE

A New Hepatitis C Treatment recently approved FDA medications.” Although hepatitis Offers Nearly 100 Percent Cure C can be cured, prudent surveillance for hepatocellular carcinoma (HCC) is mandatory. HCC remains the primary An estimated 3.2 million people in the United States indication for liver transplantation at our institution. 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 Serving Asian American therapies is crucial. A study conducted by Samuel Sigal, MD, associate professor of medicine and clinical director Communities at Risk of hepatology, has shown promising results for a new hepatitis C treatment recently approved for use by the Food With 1.1 million Asian American residents, and Drug Administration (FDA). The international, phase New York City is home to the largest population of Asian 3 study reported in The New England Journal of Medicine Americans in the United States. Unfortunately, liver demonstrated the efficacy of an interferon-free, all-oral disease is a leading cause of death in this population, antiviral therapy for previously untreated patients with and Asian Americans have the highest incidence of liver HCV genotype 1 infection and without cirrhosis. “We now cancer of any racial/ethnic group. NYU Langone’s Asian have a treatment shown to deliver close to 100 percent cure Liver Disease Program is focused specifically on the with minimal side effects, and that’s a hepatitis C game needs, diagnosis, and treatment of Asian Americans, changer,” says Dr. Sigal. NYU Langone’s liver disease program is a model — of advanced, integrated care provided by leading specialists, including hepatologists, transplant “We hope to reduce the morbidity hepatologists, interventional radiologists, GI surgeons, and mortality associated with liver surgical oncologists, transplant surgeons, and medical cancer and other liver disease oncologists. They employ a full range of modalities to in Asian Americans.” 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 providing multidisciplinary medical, surgical, and a tumor’s arterial supply. A robust research program support services. James Park, MD, assistant professor offers patients the opportunity to participate in the latest of medicine and director of the Asian Liver Disease clinical trials as NYU Langone scientists work to develop Program, explains, “By focusing on this population, we new treatments and, eventually, prevent liver disease. As hope to reduce the morbidity and mortality associated part of NYU Langone’s liver disease program, The Mary with liver cancer and other liver disease in Asian Lea Johnson Richards Organ Transplantation Center Americans, and develop new approaches to liver disease provides liver transplant, non-transplant hepatobiliary screening, diagnosis, treatment, and transplantation.” 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 Game Changer: treating hepatitis C pre- and post-transplantation. Our New Hepatitis C Treatment Delivers Close to most recent study has shown a better than 90 percent 100 Percent Cure with Minimal Side Effects success rate for post-transplant hepatitis C using the NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 19

Targeting Dendritic Cells in Liver Fibrosis Pathogenesis

Although the understanding of cellular and biochemical the elevated hepatic cytokine milieu in the fibrotic liver. factors underlying liver fibrosis is still rudimentary, an The increased inflammation and enhanced stimulation NYU Langone research study being funded by a 2014 of T cells and NK cells by dendritic cells in liver fibrosis K08 award and an R03 award from the National Institute is contingent on their elevated production of TNF-α. of Diabetes and Digestive and Kidney Diseases promises Researchers hope to determine whether dendritic cells to lead to a new area of experimental therapeutics. convert from inert inducers of tolerance to potent George Miller, MD, associate professor of surgery and immune stimulators in liver fibrosis, determine the director of the S. Arthur Localio Laboratory, is studying contributory role of dendritic cells in the pathogenesis the role of dendritic cells in the pathogenesis of liver of fibrosis and their direct role in hepatic stellate cell fibrosis. Dr. Miller’s preliminary data show that in activation, and determine whether blockade of the hepatic fibrosis, dendritic cells are remarkably effective immunogenic function of dendritic cells can mitigate at engaging both innate and adaptive immunity. the fibrogenic response to liver injury. Moreover, dendritic cells are entirely responsible for PAGE 20 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

CLINICAL CARE New Detection Tools and Advanced Therapies

ESOPHAGEAL DISEASE

A Better Biopsy for Detecting Barrett’s Esophagus

Wide-area transepithelial sampling (WATS3D) brush WATS3D approach offers promise in this area of biopsy with computer-assisted tissue analysis increases medicine.” When further treatment is needed, NYU detection of Barrett’s esophagus, according to new Langone employs a range of endoscopic interventions, research presented at the May 2014 international including endoscopic submucosal dissection (ESD), Digestive Disease Week conference and led by Seth A. endoscopic mucosal resection (EMR), radiofrequency Gross, MD, associate professor of medicine. Traditional ablation, and cryotherapy. forceps biopsy alone can leave tissue not sampled that NYU Langone’s Center for Esophageal Disease could harbor advanced dysplasia or neoplasia. By brings together specialists highly experienced in the contrast, in a study of 2,559 patients who underwent prevention, diagnosis, and treatment of the full range of upper endoscopy, the addition of WATS3D identified esophageal disease, including chronic gastroesophageal an additional 258 instances of Barrett’s esophagus— reflux disease (GERD), hiatal hernia, swallowing increasing detection by 68.4 percent. WATS3D also disorders, Barrett’s esophagus, and esophageal detected an additional 10 cases of dysplasia and one cancers. The center offers the newest diagnostic tests, cancer missed by forceps biopsy. Adjunctive use of including high-resolution manometry, pH and WATS3D increased dysplasia/neoplasia detection by impedance testing, endomicroscopy, endoscopic 64.7 percent. “In light of recent changes to Barrett’s and surgical ultrasound, and upper endoscopy as esophagus management guidelines,” says Dr. Gross, well as advanced endoscopic interventions. “improved dysplasia detection is critical—and the NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 21

New Manometry Technologies esophagus. Treatments for achalasia include pneumatic Offer Promise in Esophageal dilation laparoscopic Heller myotomy as per-oral endoscopic myotomy (POEM). Motility Disorders NYU Langone is studying the latest technologies in Lymph Node Ratio the diagnosis and treatment of reflux disease, achalasia, and other swallowing disorders. One example of this Affects Prognosis in research initiative includes evaluation of new three- Gastroesophageal Cancer dimensional (3D) high-resolution manometry for esophageal disease. “The 3D component has been found Depth of invasion and the presence or absence of lymph to be useful in anorectal manometry testing, and we are node metastasis are the most important prognostic factors now investigating the application and potential benefits in gastroesophageal cancer. But according to research of this technology for esophageal disease, including being conducted by NYU Langone, presented during achalasia and upper esophageal sphincter dysfunction,” the American College of Surgeons Clinical Congress says Abraham Khan, MD, assistant professor of in Washington, DC, in October 2013, the ratio of the 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 “Researchers are looking to see if a ensuring a complete profile and accurate diagnosis higher lymph-node ratio correlates of any potential motility disorder.” with adverse pathologic features.” — Minimally Invasive Interventions number of nodes harboring metastatic cancer for GERD and Achalasia to the total number of lymph nodes examined may affect survival after esophagogastric resection. While NYU Langone is one of the first medical centers in classification of lymph node status in patients with New York State to offer LINX for the treatment of GERD gastric cancer remains controversial, researchers are resulting from a weak lower esophageal sphincter (LES). looking to see if a higher lymph node ratio correlates LINX is a small flexible band of interlinked titanium with adverse pathologic features and is a negative beads with magnetic cores. The magnetic attraction prognostic factor in patients undergoing radical between beads helps the LES resist opening to gastric resection for gastroesophageal cancer. pressures, preventing reflux from the stomach into the PAGE 22 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

CLINICAL CARE Fighting a Difficult Cancer On Every Front

PANCREATIC DISEASE

Experienced Team short-term outcomes and long-term survival in patients Improves Outcomes aged 80 or older, and demonstrated that pancreatic resection for pancreatic adenocarcinoma or other for Patients with Complex malignancy can be performed safely and with Pancreatic Disease acceptable complication rates in well-selected octogenarians. “Multidisciplinary treatment planning According to the National Cancer Institute, and careful selection for surgery is critical,” said approximately 1.5 percent of men and women will be Dr. Melis. “But the opportunity for cure should diagnosed with pancreatic cancer at some point during not be denied to people past 80 with pancreatic their lifetime, based on 2009-2011 data. NYU Langone adenocarcinoma based solely on age. is among the top 10 performers in the nation in General Surgery in terms of mortality, according to the University HealthSystem Consortium. Pancreaticoduodenectomy outcomes of patients NYU Langone surgeons are experts in performing Whipple surgery, or pancreaticoduodenectomy—a aged 80 and older complex operation involving removal of the head of the pancreas and portions of the duodenum, gallbladder, show that the procedure can be performed bile duct and stomach—that has dramatically improved safely in this group 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 Stalling the Growth of Previously surgery, chemotherapy, radiotherapy, biologic therapy, and clinical trials at the Laura and Isaac Perlmutter Untreatable K-Ras Cancers Cancer Center at NYU Langone. For patients eligible for Whipple surgery, a subset NYU Langone researchers have found a biological of cases may warrant a laparoscopic approach. “Most weakness in the workings of the most commonly patients leave the hospital in four to six days following mutated gene involved in human cancers, mutant laparoscopic Whipple surgery compared with eight to 10 K-Ras. The gene has long been suspected of being the days following conventional Whipple surgery,” says force behind more than a third of all cancers, including Paresh C. Shah, MD, professor and chief of the Division colon, lung, and a majority of pancreatic cancers. Ras of General Surgery, who specializes in the procedure cancers are unusually aggressive and have resisted and is considered an international leader in minimally every previous attempt to stall their growth. Reporting invasive surgery for pancreatic cysts and tumors. online February 10, 2014 in Cancer Cell, researchers Research at NYU Langone has shown that Whipple in the laboratory of Dafna Bar-Sagi, PhD, senior vice surgery can also improve outcomes for octogenarian president, vice dean for science, and chief scientific patients with pancreatic adenocarcinoma. While some officer, led by Elda Grabocka, PhD, post-doctoral fellow, studies have found acceptable morbidity and mortality found that K-Ras tumor growth was highly dependent in patients over age 70, there is little data on outcomes of on the cells’ constant need to check and mend their Whipple surgery for patients over age 80. Marcovalerio DNA. This opens the door to development of Melis, MD, associate professor of surgery, studied chemotherapies designed to thwart K-Ras. NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 23

Improving Pancreatic Cyst Understanding and Management

The best approach to the monitoring and treatment Gross, MD, associate professor of medicine and of pancreatic cysts continues to be an area of study and gastroenterology section chief, is using endoscopic discussion. To collect important data in this area ultrasound combined with endomicroscopy to study of care, NYU Langone gastroenterologists, surgeons, and better characterize pancreatic cysts and their radiologists, and other specialists have developed a potential to progress to malignancy. patient registry from among the approximately 900 pancreatic cysts detected at the Medical Center each year. In addition, they have developed a Medical Experts are using Center-specific clinical algorithm to better risk-stratify patients who have pancreatic cysts. Over the next endoscopic ultrasound decade, they will be studying data gleaned from the patient registry and clinical algorithm with the goal of combined with contributing to the knowledge base around pancreatic cysts, factors that may predict malignancy, and endomicroscopy effective monitoring and treatment options. This to study and better characterize pancreatic multidisciplinary team is also employing innovative cysts and their potential to progress malignancy new approaches and technologies to optimize outcomes for patients with pancreatic cysts. For example, Seth A. PAGE 24 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

RESEARCH

Research

We continue to build upon our robust foundation in basic science and translational investigation. NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 25

Select Active Research Grants

National Institutes of Health / National Institutes of Health / American Liver Foundation R01 CA168611 R24 OD18340 Postdoctoral Fellowship Award 04/01/13–03/31/17 03/01/14–02/28/16 07/01/14–06/30/15 George Miller, MD (Principal Investigator) David Levy (Principal Investigator) Lena Tomkoetter, MD “Toll-like Receptor Regulation “Restoring Biospecimen Research Resources (Principal Investigator) of Pancreatic Tumorigenesis” Lost Due to Superstorm Sandy” “Role of Dectin-1 in liver fibrosis”

National Institutes of Health / National Institutes of Health / R01 CA164964 German Research Foundation R03 DK098303 09/01/14–06/30/18 (Federal Career Development Award) 02/15/13–02/14/15 Jiyoung Ahn, PhD 09/01/14–08/31/17 George Miller, MD (Principal Investigator) (Principal Investigator) Lena Tomkoetter, MD “Effect of dendritic cell lipid content “Prospective Study of Oral Microbiome (Principal Investigator) on hepatic inflammation and NASH with Pancreatic Cancer” “The role of γδ T cells in pathogenesis” pancreatic tumorigenesis”

Lustgarten Foundation Grant National Institutes of Health / 01/01/13–12/31/16 Ralph S. French Charitable Foundation K08 DK085278 George Miller, MD (Principal Investigator) 05/01/14–04/31/15 01/01/10–12/31/14 “Role of the intestinal microbiome in George Miller, MD (Principal Investigator) George Miller, MD (Principal Investigator) promoting pancreatic carcinogenesis” “Purchase of Mouse Ultrasound Machine “Role of dendritic cells in the pathogenesis for GI Cancer Research” of liver fibrosis” Pancreatic Cancer Action Network- AACR Innovative Grant Schwartz Research Fellowship National Institutes of Health / 07/01/14–06/30/16 in GI Oncology K08 DK085278 George Miller, MD (Principal Investigator) Donnele Daly, MD (Principal Investigator) 07/01/15–12/31/15 “Regulation of Pancreatic Tumorigenesis “The necroptosis in pancreatic tumorigenesis” George Miller, MD (Principal Investigator) by Necroptosis” “Role of dendritic cells in the pathogenesis of liver fibrosis” Doris Duke Charitable Foundation Hirschl Weill-Caulier Research Award 07/01/14 -6/30/17 01/01/11–12/31/15 Ilseung Cho, MD (Principal Investigator) DoD - Peer Reviewed George Miller, MD (Principal Investigator) “Hypermethylation as a Microbiome- Medical Research Program (PRMRP) “Dendritic cells link chronic pancreatitis to Mediated Epigenetic Phenomenon 09/01/12–08/31/15 pancreatic carcinoma” in CIMP(+) Colorectal Cancers” George Miller, MD (Principal Investigator) “Divergent Effects of Dendritic Cells on Pancreatitis” PAGE 26 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

SELECT PUBLICATIONS

Abramson SB, Jacob D, Rosenfeld M, Buckvar-Keltz L, Harnik V, Francois F, David A, Langnas E, Teperman C, Gelb B, Morgan G, Teperman L. PTC taste Rivera R, Hopkins MA, Triola M, Grossman RI. A 3-year M.D.—accelerating status and TAS2R38 genotype as a possible indicator for alcohol use in liver careers, diminishing debt. N Engl J Med. 2013;369(12):1085-1087. transplant patients. Am J Transplant. 2013;13(S5):221.

Alloway RR, Eckhoff DE, Washburn WK, Teperman LW. Conversion from twice Feld JJ, Kowdley KV, Coakley E, Sigal S, Nelson DR, Crawford D, Weiland O, daily tacrolimus capsules to once daily extended-release tacrolimus Aguilar H, Xiong J, Pilot-Matias T, DaSilva-Tillmann B, Larsen L, Podsadecki T, (LCP-Tacro): phase 2 trial of stable liver transplant recipients. Liver Transpl. Bernstein B. Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with 2014;20(5):564-575. ribavirin. N Engl J Med. 2014;370(17):1594-1603.

Asrani SK, Wiesner RH, Trotter JF, Klintmalm G, Katz E, Maller E, Roberts J, Gelb B, Layman R, Teperman L. Telaprevir based combination therapy for the Kneteman N, Teperman L, Fung JJ, Millis JM. De novo sirolimus and treatment of recurrent HCV in liver transplant recipients: promising early reduced-dose tacrolimus versus standard-dose tacrolimus after liver results late disappointment. Am J Transplant. 2013;13(S5):347. transplantation: the 2000-2003 phase II prospective randomized trial. Am J Transplant. 2014;14(2):356-366. 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. Bernstein MA, Purdy CH, Becker A, Magar R. Three-year cost-effectiveness The surgical Apgar score is associated with the need for post-operative ICU model for non-animal stabilized hyaluronic acid and dextranomer copolymer admission. [published online January 19, 2015]. J Gastrointest Surg. compared with sacral nerve stimulation after conservative therapy for the management of fecal incontinence. Clin Ther. 2014;36(6):890-905.e3. Grodstein E, Gelb B, Layman R, Mittal R, Teperman L. Nucleoside reverse transcriptase inhibitors without HBIG can be safely and cost-effectively Charlton MR, Gane EJ, Manns MP, Brown RS, Curry MP, Kwo PY, Fontana RJ, administered to prevent recurrent hepatitis B viremia post-liver transplant. Gilroy R, Teperman LW, Muir AJ, McHutchison JG, Symonds WT, Denning JM, Am J Transplant. 2013;13(S5):352. McNair L, Arterburn S, Terrault N, Samuel D, Forns X. Sofosbuvir and ribavirin for the treatment of established recurrent hepatitis C infection after liver Gurvits GE, Marsano J, Kobrinsky B, Shin S, Sanfilippo N, Volkov D. Novel use transplantation: preliminary results of a prospective, multicenter study. of endoscopically placed fiducial markers for targeted radiation therapy of Hepatology. 2013;58(6):1378A. colonic lymphomas. Ann Gastroenterol. 2014;27(4):421-423.

Cho I, Yamanishi S, Cox L, Methé BA, Zavadil J, Li K, Gao Z, Mahana D, Raju K, Hasan N, Gross SA, Gralnek IM, Pochapin M, Kiesslich R, Halpern Z. A novel Teitler I, Li H, Alekseyenko AV, Blaser MJ. Antibiotics in early life alter the balloon colonoscope detects significantly more simulated polyps than a standard murine colonic microbiome and adiposity. Nature. 2012;488(7413):621-626. colonoscope in a colon model. Gastrointest Endosc. 2014 Dec;80(6):1135-1140.

Chua DL, Hahambis T, Sigal SH. New-onset ascites as a manifestation of Hatzaras I, Sachs TE, Weiss M, Wolfgang CL, Pawlik TM. virologic relapse in patients with hepatitis C cirrhosis. Hepat Med. 2014;6:11-14. Pancreaticoduodenectomy after bariatric surgery: challenges and available techniques for reconstruction. J Gastrointest Surg. 2014;18(4):869-877. Clutter DS, Dubrovskaya Y, Merl MY, Teperman L, Press R, Safdar A. Fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid Henning JR, Graffeo CS, Rehman A, Fallon NC, Zambirinis CP, Ochi A, Barilla organ and hematopoietic stem cell transplantation with Clostridium difficile- R, Jamal M, Deutsch M, Greco S, Ego-Osuala M, Bin-Saeed U, Rao RS, Badar S, associated diarrhea. Antimicrob Agents Chemother. 2013;57(9):4501-4505. Quesada JP, Acehan D, Miller G. Dendritic cells limit fibroinflammatory injury in nonalcoholic steatohepatitis in mice. Hepatology. 2013;58(2):589-602. 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: Hochberg MS, Berman RS, Kalet AL, Zabar SR, Gillespie C, Pachter HL. The Springer; 2013:303-316. stress of residency: recognizing the signs of depression and suicide in you and your fellow residents. Am J Surg. 2013;205(2):141-146. Collins A, Hatzaras I, Schmidt C, Carruthers K, Melvin WS, Muscarella P, Ellison EC, Martin E, Bloomston M. Gastrectomy in advanced gastric cancer Hochberg MS, Billig J, Berman RS, Kalet AL, Zabar SR, Fox JR, Pachter HL. effectively palliates symptoms and may improve survival in select patients.J When surgeons decide to become surgeons: new opportunities for surgical Gastrointest Surg. 2014;18(3):491-496. education. Am J Surg. 2014;207(2):194-200.

Court H, Amoyel M, Hackman M, Lee KE, Xu R, Miller G, Bar-Sagi D, Bach EA, Jacobs RE, Bai S, Hindman N, Shah PC. Carcinoid abdominal crisis: a case Bergo MO, Philips MR. Isoprenylcysteine carboxylmethyltransferase report. J Surg Oncol. 2014;110(3):348-351. deficiency exacerbates KRAS-driven pancreatic neoplasia via Notch Katz S, Surawicz C, Pardi DS. Management of the elderly patients with suppression. J Clin Invest. 2013;123(11):4681-4694. inflammatory bowel disease: practical considerations. Inflamm Bowel Dis. Cox LM, Yamanishi S, Sohn J, Alekseyenko AV, Leung JM, Cho I, Kim SG, Li H, 2013;19(10):2257-2272. Gao Z, Mahana D, Zarate Rodriguez JG, Rogers AB, Robine N, Loke P, Blaser Khan A, Serouya S, Poles MA, Traube M, Halahalli Srinivasa VM, Chen CT, MJ. Altering the intestinal microbiota during a critical developmental window Yang L, Pei Z, Francois F. A burning issue: defining GERD in non-erosive has lasting metabolic consequences. Cell. 2014;158(4):705-721. disease. Gastroenterology. 2013;144(5 suppl 1):S851. NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 27

Lee SC, Tang MS, Lim YA, Choy SH, Kurtz ZD, Cox LM, Gundra UM, Cho I, Rao R, Graffeo CS, Gulati R, Jamal M, Narayan S, Zambirinis CP, Barilla R, Bonneau R, Blaser MJ, Chua KH, Loke P. Helminth colonization is associated with Deutsch M, Greco S, Ochi A, Tomkotter L, Blobstein R, Avanzi A, Tippens DM, increased diversity of the gut microbiota. PLoS Negl Trop Dis. 2014;8(5):e2880. Gelbstein Y, Van Heerden E, Miller G. Interleukin 17-producing γδT cells promote hepatic regeneration in mice. Gastroenterology. 2014;147(2):473-484.e2. 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 Rao RS, Graffeo CS, Gulati R, Narayan S, Mohaimin T, Greco S, Tomkoetter L, inflamed colitis tissue. Mucosal Immunol. 2014;7(1):124-133. 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 Lin IH, Wu J, Cohen SM, Chen C, Bryk D, Marr M, Melis M, Newman E, Pachter Dectin-1 dependent IL-17/IL-22 mediated inflammatory interplay. Hepatology. HL, Alekseyenko AV, Hayes RB, Ahn J. Pilot study of oral microbiome and risk 2013;58(S1):311A. of pancreatic cancer. Cancer Research. 2013;73(8 suppl). Razavi F, Gross S, Katz S. Endoscopy in the elderly: risks, benefits, and yield of Lucey MR, Terrault N, Ojo L, Hay JE, Neuberger J, Blumberg E, Teperman LW. common endoscopic procedures. Clin Geriatr Med. 2014;30(1):133-147. Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the Rehman A, Hemmert KC, Ochi A, Jamal M, Henning JR, Barilla R, Quesada JP, American Society of Transplantation. Liver Transpl. 2013;19(1):3-26. 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 Melis M, Pinna A, Marcon F, Miller G, Cohen SM, Pachter H, Newman E. dendritic cell generation and function. J Immunol. 2013;190(9):4640-4649. Lymph node ratio and survival after resection of pancreatic adenocarcinoma. J Surg Res. 2013;179(2):194. Rielland M, Cantor DJ, Graveline R, Hajdu C, Mara L, de Diego Diaz B, Miller G, David G. Senescence-associated SIN3B promotes inflammation and Melis M, Pinna A, Marcon F, Miller G, Cohen SM, Pachter H, Newman E. pancreatic cancer progression. J Clin Invest. 2014;124(5):2125-2135. Pancreaticoduodenectomy with portal vein resection for pancreatic adenocarcinoma: a 10-year experience. J Surg Res. 2013;179(2):194. Roslin MS, Dudiy Y, Brownlee A, Weiskopf J, Shah P. Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Melis M, Pinna A, Okochi S, Masi A, Rosman AS, Neihaus D, Saunders JK, Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch. Newman E, Gouge TH. Validation of the Surgical Apgar Score in a veteran Surg Endosc. 2014;28(1):91-99. population undergoing general surgery. J Am Coll Surg. 2014;218(2):218-225. Roslin MS, Oren JH, Polan BN, Damani T, Brauner R, Shah PC. Abnormal glucose Melis M, Rosen G, Hajdu CH, Pachter HL, Raccuia JS. Primary tolerance testing after gastric bypass. Surg Obes Relat Dis. 2013;9(1):26-31. rhabdomyosarcoma of the diaphragm: case report and review of the literature. J Gastrointest Surg. 2013;17(4);799-804. Safdar A, Tulliano G, Teperman L, Press R. Enterococcal colonization and disease in solid-organ versus hematologic malignancy and hematopoietic stem cell Mellgren A, Matzel K, Pollack J, Hull T, Bernstein MA, Graf W. Long term transplantation units (2000–2011). Am J Transplant. 2013;13(S5):344. efficacy of NASHA Dx injection therapy (Solesta) for treatment of fecal incontinence. Neurogastroenterol Motil. 2014 Aug;26(8). 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 Merola J, Chaudhary N, Jow A, Charles HW, Teperman L, Sigal S. TIPS creation pancreatitis. J Am Coll Surg. 2013;217(3 suppl):S17-S18. is tolerated by patients with portal vein thrombosis with high MELD scores. J Hepatol. 2013;58(suppl 1):S94. Zambirinis CP, Miller G. Signaling via MYD88 in the pancreatic tumor microenvironment: a double-edged sword. OncoImmunology. Parikh M, Chung M, Sheth S, McMacken M, Zahra T, Saunders JK, Ude-Welcome A, 2013;2(1):e22567. Dunn V, Ogedegbe G, Schmidt AM, Pachter HL. Randomized pilot trial of bariatric surgery versus intensive medical weight management on diabetes remission in Zambirinis CP, Pushalkar S, Saxena D, Miller G. Pancreatic cancer, type 2 diabetic patients who do NOT meet NIH criteria for surgery and the role of inflammation, and microbiome. Cancer J. 2014 May-Jun;20(3):195-202. soluble RAGE as a novel biomarker of success. Ann Surg. 2014;260(4):617-622. Zambirinis CP, Pushalkar S, Saxena D, Miller G. Pancreatic cancer, Parikh M, Issa R, Vieira D, McMacken M, Saunders JK, Ude-Welcome A, inflammation, and microbiome. Cancer J. 2014;20(3):195-202. 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. PAGE 28 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

LOCATIONS

1 NYU Langone Gastroenterology 6 additional Ambulatory Care Center, NY locations in 240 East 38th Street, New York, NY Westchester

2 NYU Langone Hepatology 530 First Avenue, Suite 4J, New York, NY

NYU Langone Colorectal Surgery WESTCHESTER 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 NJ 160 East 34th Street, Ninth Floor, New York, NY

4 Joan H. Tisch Center for Women’s Health BRONX 207 East 84th Street, New York, NY

5 Preston Robert Tisch Center MANHATTAN for Men’s Health

555 Madison Avenue, Second Floor, New York, NY 4 12 5 11 9 6 7 3 8 NYU Langone at Trinity Center 1 10 111 Broadway, Second Floor, New York, NY 2

6 7 NYU Langone Ambulatory Care Center- West Side QUEENS 355 West 52nd Street, Sixth Floor, New York, NY

8 NYU Langone Transplant BROOKLYN 403 East 34th Street, Third Floor, New York, NY 13 STATEN 9 NYU Langone East 35th Street ISLAND 14 245 East 35th Street, New York, NY

10 NYU Langone at Columbus Medical 97-85 Queens Boulevard, Rego Park, NY Gastroenterology and GI Surgery NYU Langone Medical Center 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

As of December 2014 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014 PAGE 29

LEADERSHIP

H. LEON PACHTER, MD MARK B. POCHAPIN, MD George David Stewart Professor of Surgery Sholtz/Leeds Professor of Gastroenterology Chair of the Department of Surgery Professor of Medicine Director, Division of Gastroenterology Vice Chair of Clinical Affairs, Department of Medicine

COLORECTAL SURGERY GASTROENTEROLOGY AND HEPATOLOGY MITCHELL A. BERNSTEIN, MD Associate Professor of Surgery ILSEUNG CHO, MD JAMES S. PARK, MD Director, Colon and Rectal Surgery Assistant Professor of Medicine Assistant Professor of Medicine Master Scholars Career Advisor Co-Director, Transplant Hepatology Director, Asian Liver Disease Program GI SURGERY FRITZ FRANÇOIS, MD Associate Professor of Medicine MARK B. POCHAPIN, MD RUSSELL S. BERMAN, MD Chief of Medicine, Tisch Hospital Sholtz/Leeds Professor of Gastroenterology Associate Professor of Surgery Professor of Medicine ADAM J. GOODMAN, MD Director, General Surgery Residency Program Director, Division of Gastroenterology Assistant Professor of Medicine Director, Surgical Oncology Director of Endoscopy, Bellevue Hospital Center MICHAEL A. POLES, MD, PhD GEORGE MILLER, MD Associate Co-Director, Associate Professor of Medicine, Associate Professor of Surgery and Cell Biology Gastroenterology Fellowship Program Microbiology, and Pathology Vice Chair of Surgical Research SETH A. GROSS, MD Gastroenterology Section Chief, ELLIOT NEWMAN, MD Associate Professor of Medicine VA NY Harbor Healthcare System – Manhattan Professor, Surgery Gastroenterology Section Chief, Director, Gastroenterology Fellowship Program Director, GI Surgical Oncology Tisch Hospital SAMUEL H. SIGAL, MD Director of Endoscopy, Tisch Hospital H. LEON PACHTER, MD Associate Professor of Medicine and Surgery George David Stewart Professor of Surgery DAVID P. HUDESMAN, MD Clinical Director, Hepatology Chair of the Department of Surgery Assistant Professor of Medicine Co-Director, Transplant Hepatology Director, Inflammatory Bowel Disease Program, HILLEL TOBIAS, MD, PhD PARESH C. SHAH, MD Tisch Hospital Professor of Surgery Clinical Professor of Medicine and Surgery Director, General Surgery SEYMOUR KATZ, MD Medical Director, Liver Transplant Vice Chair of Quality and Innovation Clinical Professor of Medicine MORRIS TRAUBE, MD, JD Associate Director, Professor of Medicine Inflammatory Bowel Disease Program Director, Center for Esophageal Disease TRANSPLANTATION ABRAHAM R. KHAN, MD GERALD A. VILLANUEVA, MD LEWIS W. TEPERMAN, MD Assistant Professor of Medicine Clinical Associate Professor of Medicine Associate Director, Associate Professor of Surgery Gastroenterology Section Chief, Center for Esophageal Disease Director, Transplantation Bellevue Hospital Center Associate Co-Director, Gastroenterology Fellowship Program ELIZABETH H. WEINSHEL, MD Professor of Medicine LISA B. MALTER, MD Director, Gastroenterology Faculty Development, Assistant Professor of Medicine Mentorship, and Leadership Program Director, Inflammatory Bowel Disease Clinic, Bellevue Hospital Center

CONTACT INFORMATION H. Leon Pachter, MD Mark B. Pochapin, MD NYU Langone Medical Center NYU Langone Medical Center 550 First Avenue NBV 15N1 Ambulatory Care Center New York, NY 10016 212.263.7669 240 East 38th Street 23rd Floor New York, NY 10016 [email protected] 646.501.2322 [email protected]

For more information about our expert physicians, visit nyulmc.org PAGE 30 NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014

LEADERSHIP

NEW YORK UNIVERSITY NYU LANGONE MEDICAL CENTER

MARTIN LIPTON, Esq. KENNETH G. LANGONE ANNETTE JOHNSON, JD, PhD Chair, Board of Trustees Chair, Board of Trustees Senior Vice President and Vice Dean, General Counsel JOHN SEXTON ROBERT I. GROSSMAN, MD President Saul J. Farber Dean and GRACE Y. KO Chief Executive Officer Senior Vice President for ROBERT BERNE, MBA, PhD Development and Alumni Affairs Executive Vice President for Health STEVEN B. ABRAMSON, MD Senior Vice President and Vice Dean KATHY LEWIS for Education, Faculty and Academic Affairs Senior Vice President for Communications and Marketing DAFNA BAR-SAGI, PhD Senior Vice President and Vice Dean JOSEPH LHOTA for Science, Chief Scientific Officer Senior Vice President and Vice Dean, Chief of Staff BERNARD A. BIRNBAUM, MD Senior Vice President and Vice Dean, VICKI MATCH SUNA, AIA Chief of Hospital Operations Senior Vice President and Vice Dean for Real Estate Development and Facilities ANDREW W. BROTMAN, MD Senior Vice President and Vice Dean NADER MHERABI for Clinical Affairs and Strategy, Senior Vice President and Vice Dean, Chief Clinical Officer Chief Information Officer

MICHAEL T. BURKE NANCY SANCHEZ Senior Vice President and Vice Dean, Senior Vice President and Vice Dean Corporate Chief Financial Officer for Human Resources and Organizational Development and Learning RICHARD DONOGHUE Senior Vice President for Strategy, Planning and Business Development

NYU LANGONE MEDICAL CENTER by the numbers*

1,069 1,408 4,000+ 650 Total Number of Beds Full-Time Faculty Publications MD Candidates 77 1,047 550,000 70 Operating Rooms Part-Time Faculty Square Feet of Research Space MD/PhD Candidates 35,666 2,500+ $245MM 252 Patient Admissions Voluntary Faculty NIH Funding PhD Candidates 1,061,552 120 $285MM 415 Hospital-Based Outpatient Visits Endowed Professorships Total Grant Funding Postdoctoral Fellows 5,422 2,515 2,053 1,155 Births Physicians Inventions Residents and Fellows 2,000,000 2,953 936 Faculty Group Practice Registered and Advanced US Patents Issued Office Visits Practice Nurses 475 550+ US Patents Licensed Allied Health Professionals

*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

Creative Direction: Ideas On Purpose, www.ideasonpurpose.com Design: Craig Williams 29 Leadership Produced by: Office of Communications and Marketing, NYU Langone NYU Langone Medical Center 550 First Avenue, New York, NY 10016 nyulmc.org

CARDIAC AND VASCULAR INSTITUTE

2014 YEAR IN REVIEW