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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
10Microbiome
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
29 Leadership
Design: Craig Williams
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
active clinical trials in GI and hepatobiliary cancer and other disease. One of our
major areas of focus is the human microbiome and its role in numerous disease
states—including obesity, inflammatory bowel disease, colorectal cancer, and
pancreatic cancer— to reveal mechanisms and markers that can be targeted
for intervention.
In the clinical arena, we deliver integrated, patient-centered, multidisciplinary
care. Our evaluation of the latest scientific and technological advances leads us
to the most optimal diagnostic and treatment options for our patients, including
full-spectrum endoscopy, endoscopic cuff-assisted colonoscopy, and capsule
colonoscopy for colon cancer screening; WATS3D brush biopsy for detection
of Barrett’s esophagus; and 3D high-resolution manometry for the diagnosis
of esophageal motility disorders.
When treatment is needed, we offer the most advanced interventions—from
newly approved medical therapies to innovative, minimally invasive endoscopic
and surgical technologies and techniques—and clinical trials that may provide
even more promising options. Recent developments include a new interferon-free
hepatitis C protocol, laparoscopic and robot-assisted surgery for GI cancers,
hyperthermic therapy for colorectal cancer, a laparoscopic approach to the
Whipple procedure for pancreatic cancer, advanced endoluminal treatments
(POEM, ESD, etc.) and partial pancreatic resections. In addition to these ongoing
advances, our faculty are contributing to the field through their leadership in
professional societies, on editorial boards, and in collaborations with local,
regional, and national community-based organizations.
With these developments, our care quality measures have been enhanced,
including lower risk-adjusted mortality and length of stay than any of the New
York institutions rated by the University HealthSystem Consortium (UHC®). We
are proud that the multidisciplinary care provided by our gastroenterologists,
hepatologists, oncologists, GI surgeons, and other specialists leads to optimal
outcomes and experience for patients suffering from the most complex and
debilitating GI and hepatobiliary conditions.
H. LEON PACHTER, MD
George David Stewart Professor of Surgery
Chair of the Department of Surgery
NYU Langone Medical Center
MARK B. POCHAPIN, MD
Sholtz/Leeds Professor of Gastroenterology
Professor of Medicine
Director of the Division of Gastroenterology
NYU Langone Medical Center
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 2
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
ENDOSCOPY
PROCEDURES
of SURGICAL RESIDENTS
perform
GASTROENTEROLOGISTS
& HEPATOLOGISTS
CLINICAL or BASIC
SCIENCE RESEARCH
including
ANNUALLY
SALARIED & VOLUNTARY FACULTY
12
93%
GASTROENTEROLOGY
& HEPATOLOGY
of Graduating Surgical Residents
GO INTO FELLOWSHIPS
PRACTICE LOCATIONS
60+
active clinical trials are under way in
GASTROINTESTINAL DISEASE,
LIVER DISEASE, AND
LIVER TRANSPLANT
*Numbers represent FY14 (Sept 2013-Aug 2014) unless otherwise noted
>50%
OF GASTROENTEROLOGY FELLOWS
over the last seven years are now in
ADVANCED FELLOWSHIPS
or ACADEMIC PRACTICE
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.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 4
NEW & NOTEWORTHY
Transformation
through Growth
and Innovation
RESEARCH
NYU Langone Receives
Significant Research Funding
for Pancreatic Disease
Investigating biochemical mediators responsible for
pancreatic tumor progression. George Miller, MD,
associate professor of surgery and director of the S.
Arthur Localio Laboratory, has received a National
Institutes of Health (NIH) $1,250,000 R01 grant for a
study of “Toll-like Receptor Regulation of Pancreatic
Tumor Genesis.” Postulating that ligation of toll-like
receptors within the inflammatory tumor stroma drives
both stromal advancement and epithelial mutagenesis
via novel signaling mechanisms, the research protocol
is designed to reveal whether blockading toll-like
receptors is a promising approach to experimental
therapeutics in pancreatic cancer.
Necroptosis as a central mechanism governing
pancreatic cancer cell demise? Funded by a $200,000
2014 Pancreatic Cancer Action Network-AACR
Innovative Grant, Dr. Miller is also investigating
whether necroptosis is a central mechanism governing
pancreatic cancer cellular demise. The research is
intended to advance the understanding of pancreatic
cancer cell biology and related development of novel
therapeutics.
Pioneering study of the oral microbiome and related
pancreatic cancer risk. Dr. Miller is the co-investigator
on a $90,000 National Cancer Institute R01 grant for a
“Prospective Study of Oral Microbiome in Pancreatic
Cancer.” The research will investigate the latest genomic
microbiome and transcriptome assays for assessing oral
and pancreas microbiota, and their possible role in
pancreatic cancer.
Exploring the gut microbiome and pancreatic cancer.
Dr. Miller is co-investigator of research funded by an
$840,000 Lustgarten Foundation grant to study the role
of the gut microbiome in the development of pancreatic
carcinogenesis.
APPOINTMENT
Laparoscopic GI Surgeon
Specialist Joins NYU Langone
NYU Langone named Paresh C. Shah, MD, chief
of the Division of General Surgery and vice chair of quality
and innovation in surgery. He specializes in laparoscopic
Whipple surgery for pancreatic cancer, other GI resections,
and therapeutic endoscopy techniques such as per-oral
endoscopic myotomy (POEM) and endoscopic submucosal
dissection (ESD). Dr. Shah is recognized internationally as
a leader in minimally invasive surgery and gastrointestinal
disease. Dr. Shah serves on the board of governors of the
Society of American Gastrointestinal and Endoscopic
Surgeons and on the editorial review boards of Surgical
Endoscopy, Journal of the American College of Surgeons,
and Surgery of Obesity & Related Diseases.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
EDUCATION
Potential New Funding for
Research Training for GI Oncology
NYU Langone has received highly favorable scores
on a recent grant application to fund “Research Training
for Physician-Scientists in Gastrointestinal Oncology”
from the NIH.
Gastrointestinal Oncology
Research Fellowship Program
among First in the Country
The new Bernard and Irene Schwartz Gastrointestinal
Oncology Fellowship Program, launched in 2014, will
be among the first in the country dedicated to training
physician-scientists in gastrointestinal cancer research.
Focus areas will include the pancreatic cancer tumor
microenvironment, the molecular basis of cancer
development, bacteria and viruses that influence cancer
development, and gastrointestinal inflammation that
can lead to cancer.
PAGE 5
Gastroenterology Fellowship
Program Produces IBD iBook
With support from an American Gastroenterological
Association education grant, Sophie M. Balzora, MD,
assistant professor of medicine; Lisa Malter, MD,
assistant professor of medicine; and Martin Wolff, MD,
senior gastroenterology fellow, developed the new iBook,
NYU Langone Gastroenterology Fellowship Training
Program Pocket Guide: Key Concepts in Managing
Patients with Inflammatory Bowel Disease (IBD).
The new resource is designed to be used on iPads or
smart-phones in the management of Crohn’s disease
and ulcerative colitis. The changing landscape of
therapeutics makes treating patients with IBD complex,
so it’s increasingly important for gastroenterology
fellows to understand the complete care of IBD patients.
The “pocket guide” was created to supplement
gastroenterology fellowship education by providing
a comprehensive, case-based, quick reference to
managing IBD. The iBook was created in collaboration
with the NYU School of Medicine Institute for
Innovations in Medical Education. The iBook can be
downloaded at iTunes, https://itunes.apple.com/us/
book/key-concepts-in-managing-patients/
id915394601?mt=11.
EXPANSION
OUTREACH
Gift Propels Growth of
Cancer Center
Providing Evidence for the
Adverse Effects of Antibiotics
Benjamin G. Neel, MD, PhD, assumed the directorship
of the Laura and Isaac Perlmutter Cancer Center (formerly
NYU Cancer Institute) in January 2014. A world-renowned
cancer biologist, Dr. Neel previously directed the Torontobased Ontario Cancer Institute, Canada’s largest cancer
research center. The Perlmutter Cancer Center is poised for
growth following a gift in excess of $50 million from the
Laura and Isaac Perlmutter Foundation to advance cancer
research and treatment at NYU Langone.
Missing Microbes: How the Overuse of Antibiotics
Is Fueling Our Modern Plagues by Martin Blaser, MD,
was published in 2014 and was favorably reviewed by
The New York Times. The book provides evidence for the
adverse effects of antibiotics, and tells what can be done
to avoid catastrophic health problems in the future. Dr.
Blaser is the Muriel G. and George W. Singer Professor
of Translational Medicine and director of the Human
Microbiome Program.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 6
NEW & NOTEWORTHY
OUTREACH
Engaging with the Media to
Promote Colon Cancer
Screening
According to the American Cancer Society, colon
cancer incidence has decreased by 30 percent over the
last decade in large part due to an increase in colon
cancer screening. However far too many people still
forgo screening. NYU Langone is committed to helping
everyone understand how screening saves lives.
Sandra Turns 50 is a short animation developed by
NYU Langone and funded by a New York Society for
Gastrointestinal Endoscopy Florence Lefcourt Award
designed to dispel misperceptions about colon cancer
and encourage screening. Using engaging graphics and
easy-to-follow narration, the video is the newest tool in
NYU Langone’s robust community outreach program,
and can be viewed on YouTube.
In another novel approach to community education
and outreach, Jonathan LaPook, MD, the Mebane
Professor of Gastroenterology and CBS News chief
medical correspondent, hosted a Google+ Hangout
with Mark B. Pochapin, MD, the Sholtz/Leeds Professor
of Gastroenterology and director of the Division of
Gastroenterology, and Gina Mileo, RN. The trio took
questions from participants about the importance of
colon cancer screening recommendations and options.
As a frequent contributor to Fox News, Today,
CNN, and ABC News, Roshini Rajapaksa, MD, associate
professor of medicine, is also spreading the word about
the importance of colon cancer screening. She specializes
in women’s health issues and has published several
studies related to colon cancer screening.
PARAESOPHAGEAL HERNIAS
Repairing 100 Percent of
Paraesophageal and Hiatal
Hernias Laparoscopically
All repair of paraesophageal and hiatal hernias is
performed laparoscopically at NYU Langone, helping
to reduce length of stay and improve patient experience.
Paraesophageal hernias are on the rise, and NYU
Langone is also a high-volume center, performing
close to 50 repairs a year.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
Awards and Recognitions
afna Bar-Sagi, PhD, senior vice president, vice dean for
D
science, and chief scientific officer, received a 2014 Pancreatic
Cancer Action Network - AACR Innovative Grant to study
whether anatomical location in the pancreas can dictate the
course of tumor development. In 70 to 80 percent of cases,
pancreatic ductal adenocarcinoma develops in the pancreas
head and uncinate process regions, leading to speculation
about the importance of location in tumor development.
Martin J. Blaser, MD, the Muriel G. and George W. Singer
Professor of Translational Medicine and director of the
Human Microbiome Program, received the Pancreatic
Cancer Action Network-AACR Innovative Award.
ussell S. Berman, MD, associate professor of surgery,
R
won the 2014 Alpha Omega Alpha Alumni Award and was
appointed chairman of the Society of Surgical Oncology
SCORE Committee. He is also an associate examiner for the
American Board of Surgery, associate editor of the Journal of
the National Cancer Institute, and a member of the National
Cancer Institute’s PDQ® Adult Treatment Editorial Board.
I lseung Cho, MD, assistant professor of medicine, received
a 2014 Clinical Scientist Development Award from the Doris
Duke Charitable Foundation. The award will support Dr.
Cho’s research into the role of the human microbiome in the
development of colon cancer. He hypothesizes that the
human microbiome may cause hypermethylation of specific
DNA repair genes, impairing the body’s ability to repair
damaged cells and leading to precancerous and cancerous
lesions. Dr. Cho’s previous research revealed possible links
between the human microbiome and obesity, and was
published in Nature and Cell.
itchell A. Bernstein, MD, associate professor and director,
M
colon and rectal surgery, and Harvey G. Moore, MD, assistant
professor of surgery, are collaborating with principal
investigator Cynthia G. Leichman, MD, to examine the “Gene
Methylation Profile of Rectal Cancer and its Predictive Value
for Response to Neoadjuvant Chemoradiation Therapy.”
udio-Digest Foundation’s General Surgery Board Review will
A
feature a course on Anal Cancer by Mitchell A. Bernstein, MD.
ea Ann Chen, MD, instructor in medicine, was elected vice
L
chair of the New York Crohn’s and Colitis Organization and
serves on the organization’s executive council.
onnele Daley, MD, teaching assistant in the Department
D
of Surgery, received the Schwartz GI Fellowship for her
research work under the mentorship of George Miller , MD.
PAGE 7
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 8
NEW & NOTEWORTHY
George A. Fielding, MD, the J. Ira and Nicki Harris Family
Professor of Surgery and Bariatric Medicine, was named one
of the 30 most influential members of the American Society
of Metabolic and Bariatric Surgery over the last 30 years.
ritz François, MD, associate professor of medicine, was
F
named recipient of the American College of Gastroenterology’s
Minority Digestive Health Care Award. The judges cited his
active involvement in clinical practice/clinical research and
efforts to improve the digestive health of a minority group or
underserved population.
dam J. Goodman, MD, assistant professor of medicine
A
and director of endoscopy at Bellevue Hospital Center,
has been named vice president of the New York Society for
Gastrointestinal Endoscopy. He will become the society’s
president in 2015.
eth A. Gross, MD, associate professor of medicine and
S
gastroenterology section chief, was appointed an associate
editor of the American Society for Gastrointestinal
Endoscopy (ASGE) journal Gastrointestinal Endoscopy.
He also serves on the ASGE practice management committee,
and on the American College of Gastroenterology (ACG)
training committee, and educational affairs committee.
He is editor of ACG Universe and is the ACG’s American
Board of Internal Medicine liaison.
orman B. Javitt, MD, PhD, professor of medicine and
N
pediatrics, won the American Physiological Society’s
History of Physiology Group 2014 Recognition Award for
his presentation, “The History of Hepatic Bile Formation:
Investigator’s Dilemma; Patient’s Problems,” presented
at Experimental Biology 2014.
eymour Katz, MD, clinical professor of medicine, was
S
named to the New York Crohn’s and Colitis Organization
executive council.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
arvey G. Moore, MD, assistant professor of surgery,
H
received the “Works in Progress Award” from the American
Society of Colon and Rectal Surgeons Research Foundation
for his paper, “Novel Inhibitors of WNT/β-Catenin
Responsive Transcription Augment Response of HCT116
CRC Cells to Radiation In Vitro and In Vivo.” He was also
named a total mesorectal excision-credentialed surgeon
by the Alliance for Clinical Trials in Oncology and serves
on the Fundamentals of Rectal Cancer Surgery Committee
of the American Society of Colon and Rectal Surgeons.
. Leon Pachter, MD, the George David Stewart Professor
H
of Surgery and chair of the Department of Surgery, serves on
the editorial boards of Annals of Surgery and The Journal of
Trauma and Critical Care.
ark B. Pochapin, MD, the Sholtz/Leeds Professor
M
of Gastroenterology and director of the Division of
Gastroenterology, has been reappointed to the steering
committee of the National Colorectal Cancer Roundtable.
PAGE 9
He also serves on the board of trustees of the American
College of Gastroenterology (ACG) and as director and
treasurer of the ACG and American Society for Gastrointestinal
Endoscopy’s collaborative GIQuIC quality initiative.
aresh C. Shah, MD, professor of surgery and vice chair
P
of quality and innovation in surgery, was the recipient of
the Excellence in Medical Leadership Award from the Society
of American Gastrointestinal and Endoscopic Surgeons.
lejandro Torres-Hernandez, MD, postdoctoral fellow
A
under the mentorship of Dr. George Miller, was awarded
the “Emerging Liver Scholar Award” from the American
Association for the Study of Liver Diseases.
ewis W. Teperman, MD, associate professor of surgery,
L
was named Physician of the Year in 2014 by the American
Liver Association Greater New York Division.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 10
THE HUMAN MICROBIOME
The Human
Microbiome
YU Langone researchers are dedicated to fully
N
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
Microbiome Alterations
Bacteria living in the human gastrointestinal tract
outnumber human cells by a factor of 10—and the
aggregate genetic information contained within those
bacteria is several magnitudes greater than that found
in the host human genome. This emerging field of
research is revealing that perturbing our resident
microbial communities at critical time points can have
damaging—and lasting—consequences. Martin J. Blaser,
MD, the Muriel G. and George W. Singer Professor of
Translational Medicine and director of the Human
Microbiome Program, is leading a research team to
shed new light on how antibiotics can profoundly
reshape the microbial communities that live within
us and contribute to chronic conditions.
According to this research, conducted by Ilseung Cho,
MD, assistant professor of medicine, these alterations
in the gut microbiome may be driving certain cases of
obesity. Sub-therapeutic antibiotics are regularly given
to animals in the agricultural industry to promote
growth by allowing feed to be more thoroughly digested
and absorbed. Those antibiotics subsequently enter the
food chain and may promote similar effects in humans.
There may also be a link between obesity and the
over-prescription of therapeutic antibiotics in humans
for various childhood infections. “We’ve developed a
murine model to demonstrate that exposure to low-dose
antibiotics can permanently change the gut microbiome,
leading to weight gain and altered body composition,”
says Dr. Cho. NYU Langone is dedicated to fully
understanding the gut, the immune system’s largest
sensory organ; gut microbiome; and its role in
gastrointestinal disease, prevention, and treatment.
Investigating Gut Microbiome
Changes in Pediatric Patients
with C. difficile Colitis
According to the to the Centers for Disease Control
and Prevention, about 14,000 Americans die each year
from Clostridium difficile, or C. diff, infection. Antibiotics
often can be ineffective in treating this infection, and
fecal microbial transplant has been demonstrated in
most studies to date to be more than 90 percent effective
in treating C. diff cases in patients who do not respond
to conventional antibiotic therapies.
In a collaborative effort with the Johns Hopkins
School of Medicine, NYU Langone’s Lea Ann Chen,
MD, instructor of medicine, is investigating the gut
microbiome of pediatric patients ages 6 to 17 with
C. diff colitis who have failed conventional therapies,
observing changes following fecal transplant. Each
patient serves as his or her own control; researchers
collect stool samples before and after fecal transplant.
As a second control, researchers collect stool samples
from fecal transplant donors (usually an adult
family member).
As she explains, “We’re evaluating the differences
between the gut microbiome of healthy donors and
children who have recurrent C. diff infections requiring
fecal transplant, to better understand why the transplants
work and why certain patients, such as those with
inflammatory bowel disease, are at increased risk
for recurrent C. diff infections.”
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 12
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.
Revealing the interplay between inflammation and the
microbiome in the context of pancreatic cancer will
provide novel targets for prevention and treatment.
Bacteria living in the human
gastrointestinal tract
outnumber human cells by a
factor of 10
EVIDENCE SHOWS GUT VIRUSES
ALSO PLAY ROLE IN INTESTINAL
ECOSYSTEM
NYU Langone microbiologists have
what may be the first strong evidence
that the natural presence of viruses
in the gut—or the “virome”—plays a
health maintenance and infectionfighting role similar to that of intestinal
bacteria. In a series of experiments
reported November 19, 2014 in Nature
Online, researchers found that infection
with the common murine norovirus
helped mice repair intestinal tissue
damaged by inflammation and restore
the gut’s immune defenses after its
microbiome had been wiped out by
antibiotic therapy. They also report
that murine norovirus bolstered the
immune system. “Our research offers
compelling data about the mutually
supportive relationship between
viruses and bacteria in the mouse gut,
and lays the groundwork for further
research on precisely how the virome
supports the immune system,”
concludes Ken Cadwell, PhD, assistant
professor of microbiology and principal
investigator of the Cadwell Laboratory.
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.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 14
CLINICAL CARE
Clinical
Care
ur clinicians are leading the way
O
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
cancer screening, and NYU Langone gastroenterologists
are among the first in the nation to offer the latest
colonoscopy technologies and techniques. “The
focus remains always on quality in endoscopy,” says
Mark B. Pochapin, MD, the Sholtz/Leeds Professor
of Gastroenterology and director of the Division
of Gastroenterology, “along with a positive patient
experience for this life-saving screening.”
•F
ull-spectrum endoscopy technology. While
traditional colonoscopy provides a 170-degree view
of the colon, the new full-spectrum endoscopy
technology allows for a 330-degree visual field.
This new, expanded optical view offers promise
in enhancing the endoscopist’s ability to spot
potentially hidden polyps and thus increase polyp/
adenoma detection rates.
• Endoscopic cuff-assisted colonoscopy. With
endoscopic cuff-assisted colonoscopy, a soft, flexible
projection is attached to the end of the colonoscope.
During withdrawal, the tiny flexible fingers of the
cuff help grip the colon wall to mechanically flatten
folds and enhance visualization of potentially
hidden polyps.
•N
ew FDA-approved colon capsule endoscopy.
NYU Langone gastroenterologists offer the new,
Food and Drug Administration (FDA)-approved
colon capsule endoscopy for the small subgroup of
patients who undergo an incomplete colonoscopy.
The camera pill is utilized to capture images from
the area of the colon that could not be viewed
during the original colonoscopy procedure.
•A
non-oral, same-day prep regimen. NYU
Langone offers select patients the option of colonic
irrigation—a bowel prep technique for patients
whose co-morbidities contraindicate the use of
the oral prep, who cannot tolerate the oral prep
regimen, or for whom the oral prep is insufficient
to allow for effective visualization of the colon.
This technique offers a non-oral, same-day prep
regimen for patients in need of this option.
•B
alloon-assisted colonoscopy. Balloon-assisted
colonoscopy is being evaluated for effectiveness
by NYU Langone gastroenterologists. With this
technique, the colonoscopy is fitted with an
integrated, reusable balloon. Upon reaching the
cecum, the balloon is inflated. As the colonoscope
is withdrawn, the balloon acts to smooth out folds
on the colon wall. In a recent multicenter tandem
study presented at national and international
conferences, Seth A. Gross, MD, associate professor
of medicine and gastroenterology section chief;
Mark B. Pochapin, MD, the Sholtz/Leeds Professor
of Gastroenterology and director of the Division
of Gastroenterology; and colleagues compared
balloon-assisted with traditional colonoscopy,
finding improved polyp and adenoma detection
rates with the balloon-assisted technology.
PAGE 16
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
CLINICAL CARE
Minimally-invasive
Approaches Preserve Function
and Shorten Recovery
NYU Langone is at the forefront of minimally
invasive surgery (including the TAMIS transanal
minimally invasive technique), with the vast majority
of colorectal surgeries performed laparoscopically
compared to approximately 20 percent nationally. NYU
Langone was the first medical center in New York City to
perform colorectal surgery robotically over a decade ago.
Experts at the Robotic Surgery Center are international
leaders in performing a wide range of minimally
invasive procedures with robotic assistance. “The robot
can be helpful particularly with colorectal cancer
situated in the lower rectum,” explains Elliot Newman,
MD, professor of surgery, “where the robot’s precision
and maneuverability help preserve normal bowel
function and can avoid the need for permanent
colostomy.” Surgeons perform more than 1,600 robotassisted surgeries each year in dedicated operating
rooms using one of five state-of-the-art surgical systems
that include advanced infrared imaging, dual consoles,
and the latest da Vinci® Si and Xi surgical systems.
NYU Langone gastroenterologists also use minimally
invasive colonoscopic techniques, including endoscopic
mucosal resection (EMR) and endoscopic submucosal
dissection (ESD) to remove large polyps and early-stage
cancer of the rectum without a major operation. “Within
the context of personalized patient care,” says Dr.
Newman, “NYU Langone offers a full range of minimally
invasive surgical and endoscopic procedures for
colorectal cancer when they are appropriate and may
result in faster recovery and reduced length of stay.”
Hyperthermic Intraperitoneal
Chemotherapy (HIPEC) Plus
Cytoreductive Surgery
Applied to Colorectal Tumors
NYU Langone has an active program to treat
peritoneal surface malignancy. Under certain
circumstances, gastrointestinal tract malignancies
and other types of tumors can spread along the linings
of the intra-abdominal organs and the inner lining of
the abdominal wall itself. Sometimes, this is more
gelatinous or liquid than solid. This process is commonly
called carcinomatosis or pseudomyxoma (if more
gelatinous). With colorectal and appendiceal cancers,
and even appendiceal tumors that are not clearly cancer,
this type of spread can be treated by debulking the
tumor strips or masses through cytoreductive surgery
followed by direct installation of heated chemotherapy
(hyperthermic intraperitoneal chemotherapy, or HIPEC)
into the abdominal cavity during surgery. This approach
may also be an option for other types of cancers. By
delivering chemotherapy directly, HIPEC enables
drug-to-tumor contact, increases efficacy, allows for a
much higher chemotherapy concentration than would
be possible with intravenous therapy, and minimizes
side effects, notes Russell S. Berman, MD, associate
professor of surgery.
Promoting Colon Cancer
Screening in the African
American Community
Focusing on barriers to care in the African American
community, particularly in relation to increasing colon
cancer screening, Joseph Ravenell, MD, assistant
professor of medicine, has identified intrinsic and
extrinsic barriers to health and primary healthcare use
among African Americans in a low-income, urban area.
Expanding on community-based research models that
Dr. Ravenell and Olugbenga G. Ogedegbe, MD, professor
of population health and medicine and director of NYU
Langone’s Center for Healthful Behavior Change,
developed around hypertension, Dr. Ravenell is leading
National Institutes of Health (NIH)-funded research
utilizing a faith-based approach to colon cancer
screening in the New York City African American
community. As part of this cluster-randomized
controlled trial, Dr. Ravenell’s team has provided
educational interventions about colorectal cancer in 89
churches and mosques, reaching nearly 3,380 black men
age 50 and older and enrolling 451 participants in the
study. Additionally, they have trained over 100 lay health
workers at these churches to deliver colorectal cancer
screening information to their congregations. The
researchers hope this program will serve as a new model
for evidence-based education/outreach and linking
faith-based settings to the healthcare system, thereby
increasing colon cancer screening in African American
men nationwide.
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.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 18
CLINICAL CARE
New Hope
for Those at Risk
LIVER DISEASE
A New Hepatitis C Treatment
Offers Nearly 100 Percent Cure
An estimated 3.2 million people in the United States
have chronic hepatitis C infection, and approximately
75 percent of them are baby boomers. With such a large
number affected, finding better, less toxic medical
therapies is crucial. A study conducted by Samuel Sigal,
MD, associate professor of medicine and clinical director
of hepatology, has shown promising results for a new
hepatitis C treatment recently approved for use by the Food
and Drug Administration (FDA). The international, phase
3 study reported in The New England Journal of Medicine
demonstrated the efficacy of an interferon-free, all-oral
antiviral therapy for previously untreated patients with
HCV genotype 1 infection and without cirrhosis. “We now
have a treatment shown to deliver close to 100 percent cure
with minimal side effects, and that’s a hepatitis C game
changer,” says Dr. Sigal.
NYU Langone’s liver disease program is a model
of advanced, integrated care provided by leading
specialists, including hepatologists, transplant
hepatologists, interventional radiologists, GI surgeons,
surgical oncologists, transplant surgeons, and medical
oncologists. They employ a full range of modalities to
diagnose and treat liver disease, including minimally
invasive robotic and laparoscopic surgery, ablation for
lesions not amenable to direct resection, and directed
radiation therapy to deliver microspheres directly into
a tumor’s arterial supply. A robust research program
offers patients the opportunity to participate in the latest
clinical trials as NYU Langone scientists work to develop
new treatments and, eventually, prevent liver disease. As
part of NYU Langone’s liver disease program, The Mary
Lea Johnson Richards Organ Transplantation Center
provides liver transplant, non-transplant hepatobiliary
surgery, and liver cancer resection. Lewis Teperman,
MD, associate professor of surgery and director of the
Mary Lea Richards Organ Transplantation Center says,
“The liver transplant program has been at the forefront of
treating hepatitis C pre- and post-transplantation. Our
most recent study has shown a better than 90 percent
success rate for post-transplant hepatitis C using the
recently approved FDA medications.” Although hepatitis
C can be cured, prudent surveillance for hepatocellular
carcinoma (HCC) is mandatory. HCC remains the primary
indication for liver transplantation at our institution.
Serving Asian American
Communities at Risk
With 1.1 million Asian American residents,
New York City is home to the largest population of Asian
Americans in the United States. Unfortunately, liver
disease is a leading cause of death in this population,
and Asian Americans have the highest incidence of liver
cancer of any racial/ethnic group. NYU Langone’s Asian
Liver Disease Program is focused specifically on the
needs, diagnosis, and treatment of Asian Americans,
—
“We hope to reduce the morbidity
and mortality associated with liver
cancer and other liver disease
in Asian Americans.”
—
providing multidisciplinary medical, surgical, and
support services. James Park, MD, assistant professor
of medicine and director of the Asian Liver Disease
Program, explains, “By focusing on this population, we
hope to reduce the morbidity and mortality associated
with liver cancer and other liver disease in Asian
Americans, and develop new approaches to liver disease
screening, diagnosis, treatment, and transplantation.”
Game Changer
:
New Hepatitis C Treatment Delivers Close to
100 Percent Cure with Minimal Side Effects
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
factors underlying liver fibrosis is still rudimentary, an
NYU Langone research study being funded by a 2014
K08 award and an R03 award from the National Institute
of Diabetes and Digestive and Kidney Diseases promises
to lead to a new area of experimental therapeutics.
George Miller, MD, associate professor of surgery and
director of the S. Arthur Localio Laboratory, is studying
the role of dendritic cells in the pathogenesis of liver
fibrosis. Dr. Miller’s preliminary data show that in
hepatic fibrosis, dendritic cells are remarkably effective
at engaging both innate and adaptive immunity.
Moreover, dendritic cells are entirely responsible for
the elevated hepatic cytokine milieu in the fibrotic liver.
The increased inflammation and enhanced stimulation
of T cells and NK cells by dendritic cells in liver fibrosis
is contingent on their elevated production of TNF-α.
Researchers hope to determine whether dendritic cells
convert from inert inducers of tolerance to potent
immune stimulators in liver fibrosis, determine the
contributory role of dendritic cells in the pathogenesis
of fibrosis and their direct role in hepatic stellate cell
activation, and determine whether blockade of the
immunogenic function of dendritic cells can mitigate
the fibrogenic response to liver injury.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 20
CLINICAL CARE
New Detection Tools
and Advanced Therapies
ESOPHAGEAL DISEASE
A Better Biopsy for Detecting Barrett’s Esophagus
Wide-area transepithelial sampling (WATS3D) brush
biopsy with computer-assisted tissue analysis increases
detection of Barrett’s esophagus, according to new
research presented at the May 2014 international
Digestive Disease Week conference and led by Seth A.
Gross, MD, associate professor of medicine. Traditional
forceps biopsy alone can leave tissue not sampled that
could harbor advanced dysplasia or neoplasia. By
contrast, in a study of 2,559 patients who underwent
upper endoscopy, the addition of WATS3D identified
an additional 258 instances of Barrett’s esophagus—
increasing detection by 68.4 percent. WATS 3D also
detected an additional 10 cases of dysplasia and one
cancer missed by forceps biopsy. Adjunctive use of
WATS3D increased dysplasia/neoplasia detection by
64.7 percent. “In light of recent changes to Barrett’s
esophagus management guidelines,” says Dr. Gross,
“improved dysplasia detection is critical—and the
WATS 3D approach offers promise in this area of
medicine.” When further treatment is needed, NYU
Langone employs a range of endoscopic interventions,
including endoscopic submucosal dissection (ESD),
endoscopic mucosal resection (EMR), radiofrequency
ablation, and cryotherapy.
NYU Langone’s Center for Esophageal Disease
brings together specialists highly experienced in the
prevention, diagnosis, and treatment of the full range of
esophageal disease, including chronic gastroesophageal
reflux disease (GERD), hiatal hernia, swallowing
disorders, Barrett’s esophagus, and esophageal
cancers. The center offers the newest diagnostic tests,
including high-resolution manometry, pH and
impedance testing, endomicroscopy, endoscopic
and surgical ultrasound, and upper endoscopy as
well as advanced endoscopic interventions.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
New Manometry Technologies
Offer Promise in Esophageal
Motility Disorders
NYU Langone is studying the latest technologies in
the diagnosis and treatment of reflux disease, achalasia,
and other swallowing disorders. One example of this
research initiative includes evaluation of new threedimensional (3D) high-resolution manometry for
esophageal disease. “The 3D component has been found
to be useful in anorectal manometry testing, and we are
now investigating the application and potential benefits
of this technology for esophageal disease, including
achalasia and upper esophageal sphincter dysfunction,”
says Abraham Khan, MD, assistant professor of
medicine. “We’re offering the new 3D technology
in addition to the high-resolution component of
esophageal manometry, which allows for simultaneous
testing of pressures from the pharynx to stomach, thus
ensuring a complete profile and accurate diagnosis
of any potential motility disorder.”
PAGE 21
esophagus. Treatments for achalasia include pneumatic
dilation laparoscopic Heller myotomy as per-oral
endoscopic myotomy (POEM).
Lymph Node Ratio
Affects Prognosis in
Gastroesophageal Cancer
Depth of invasion and the presence or absence of lymph
node metastasis are the most important prognostic factors
in gastroesophageal cancer. But according to research
being conducted by NYU Langone, presented during
the American College of Surgeons Clinical Congress
in Washington, DC, in October 2013, the ratio of the
—
“Researchers are looking to see if a
higher lymph-node ratio correlates
with adverse pathologic features.”
—
Minimally Invasive Interventions
for GERD and Achalasia
NYU Langone is one of the first medical centers in
New York State to offer LINX for the treatment of GERD
resulting from a weak lower esophageal sphincter (LES).
LINX is a small flexible band of interlinked titanium
beads with magnetic cores. The magnetic attraction
between beads helps the LES resist opening to gastric
pressures, preventing reflux from the stomach into the
number of nodes harboring metastatic cancer
to the total number of lymph nodes examined may
affect survival after esophagogastric resection. While
classification of lymph node status in patients with
gastric cancer remains controversial, researchers are
looking to see if a higher lymph node ratio correlates
with adverse pathologic features and is a negative
prognostic factor in patients undergoing radical
resection for gastroesophageal cancer.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 22
CLINICAL CARE
Fighting a Difficult Cancer
On Every Front
PANCREATIC DISEASE
Experienced Team
Improves Outcomes
for Patients with Complex
Pancreatic Disease
According to the National Cancer Institute,
approximately 1.5 percent of men and women will be
diagnosed with pancreatic cancer at some point during
their lifetime, based on 2009-2011 data. NYU Langone
is among the top 10 performers in the nation in General
Surgery in terms of mortality, according to the
University HealthSystem Consortium.
NYU Langone surgeons are experts in performing
Whipple surgery, or pancreaticoduodenectomy—a
complex operation involving removal of the head of the
pancreas and portions of the duodenum, gallbladder,
bile duct and stomach—that has dramatically improved
outcomes for eligible patients. Pancreatic resection and
Whipple provide important options for eligible patients
and the opportunity for long-term survival. Regardless
of stage, we offer a full spectrum of options including
surgery, chemotherapy, radiotherapy, biologic therapy,
and clinical trials at the Laura and Isaac Perlmutter
Cancer Center at NYU Langone.
For patients eligible for Whipple surgery, a subset
of cases may warrant a laparoscopic approach. “Most
patients leave the hospital in four to six days following
laparoscopic Whipple surgery compared with eight to 10
days following conventional Whipple surgery,” says
Paresh C. Shah, MD, professor and chief of the Division
of General Surgery, who specializes in the procedure
and is considered an international leader in minimally
invasive surgery for pancreatic cysts and tumors.
Research at NYU Langone has shown that Whipple
surgery can also improve outcomes for octogenarian
patients with pancreatic adenocarcinoma. While some
studies have found acceptable morbidity and mortality
in patients over age 70, there is little data on outcomes of
Whipple surgery for patients over age 80. Marcovalerio
Melis, MD, associate professor of surgery, studied
short-term outcomes and long-term survival in patients
aged 80 or older, and demonstrated that pancreatic
resection for pancreatic adenocarcinoma or other
malignancy can be performed safely and with
acceptable complication rates in well-selected
octogenarians. “Multidisciplinary treatment planning
and careful selection for surgery is critical,” said
Dr. Melis. “But the opportunity for cure should
not be denied to people past 80 with pancreatic
adenocarcinoma based solely on age.
Pancreaticoduodenectomy outcomes of patients
aged 80 and older
show that the procedure can be performed
safely in this group
Stalling the Growth of Previously
Untreatable K-Ras Cancers
NYU Langone researchers have found a biological
weakness in the workings of the most commonly
mutated gene involved in human cancers, mutant
K-Ras. The gene has long been suspected of being the
force behind more than a third of all cancers, including
colon, lung, and a majority of pancreatic cancers. Ras
cancers are unusually aggressive and have resisted
every previous attempt to stall their growth. Reporting
online February 10, 2014 in Cancer Cell, researchers
in the laboratory of Dafna Bar-Sagi, PhD, senior vice
president, vice dean for science, and chief scientific
officer, led by Elda Grabocka, PhD, post-doctoral fellow,
found that K-Ras tumor growth was highly dependent
on the cells’ constant need to check and mend their
DNA. This opens the door to development of
chemotherapies designed to thwart K-Ras.
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
of pancreatic cysts continues to be an area of study and
discussion. To collect important data in this area
of care, NYU Langone gastroenterologists, surgeons,
radiologists, and other specialists have developed a
patient registry from among the approximately 900
pancreatic cysts detected at the Medical Center each
year. In addition, they have developed a Medical
Center-specific clinical algorithm to better risk-stratify
patients who have pancreatic cysts. Over the next
decade, they will be studying data gleaned from the
patient registry and clinical algorithm with the goal of
contributing to the knowledge base around pancreatic
cysts, factors that may predict malignancy, and
effective monitoring and treatment options. This
multidisciplinary team is also employing innovative
new approaches and technologies to optimize outcomes
for patients with pancreatic cysts. For example, Seth A.
Gross, MD, associate professor of medicine and
gastroenterology section chief, is using endoscopic
ultrasound combined with endomicroscopy to study
and better characterize pancreatic cysts and their
potential to progress to malignancy.
Experts are using
endoscopic ultrasound
combined with
endomicroscopy
to study and better characterize pancreatic
cysts and their potential to progress malignancy
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 24
RESEARCH
Research
e continue to build upon our robust
W
foundation in basic science and
translational investigation.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 25
Select Active
Research Grants
American Liver Foundation
National Institutes of Health /
Postdoctoral Fellowship Award
R24 OD18340
07/01/14–06/30/15
03/01/14–02/28/16
Lena Tomkoetter, MD
David Levy (Principal Investigator) (Principal Investigator)
“Restoring Biospecimen Research Resources
“Role of Dectin-1 in liver fibrosis”
Lost Due to Superstorm Sandy”
National Institutes of Health / R01 CA164964 German Research Foundation
National Institutes of Health /
(Federal Career Development Award)
R03 DK098303 09/01/14–06/30/18
09/01/14–08/31/17
Jiyoung Ahn, PhD
02/15/13–02/14/15
Lena Tomkoetter, MD
(Principal Investigator)
George Miller, MD (Principal Investigator)
(Principal Investigator)
“Prospective Study of Oral Microbiome
“Effect of dendritic cell lipid content
“The role of γδ T cells in
with Pancreatic Cancer” on hepatic inflammation and NASH
pancreatic tumorigenesis”
pathogenesis”
National Institutes of Health /
R01 CA168611
04/01/13–03/31/17
George Miller, MD (Principal Investigator)
“Toll-like Receptor Regulation
of Pancreatic Tumorigenesis”
Lustgarten Foundation Grant
Ralph S. French Charitable Foundation
01/01/13–12/31/16
National Institutes of Health /
05/01/14–04/31/15
K08 DK085278 George Miller, MD (Principal Investigator)
George Miller, MD (Principal Investigator)
“Role of the intestinal microbiome in
01/01/10–12/31/14
“Purchase of Mouse Ultrasound Machine
promoting pancreatic carcinogenesis”
George Miller, MD (Principal Investigator)
for GI Cancer Research”
“Role of dendritic cells in the pathogenesis
of liver fibrosis”
Pancreatic Cancer Action NetworkSchwartz Research Fellowship
AACR Innovative Grant
in GI Oncology
07/01/14–06/30/16
National Institutes of Health /
Donnele Daly, MD (Principal Investigator)
K08 DK085278 George Miller, MD (Principal Investigator)
“The necroptosis in pancreatic tumorigenesis”
“Regulation of Pancreatic Tumorigenesis
07/01/15–12/31/15
by Necroptosis”
George Miller, MD (Principal Investigator)
“Role of dendritic cells in the
Doris Duke Charitable Foundation
pathogenesis of liver fibrosis”
07/01/14 -6/30/17
Hirschl Weill-Caulier Research Award
Ilseung Cho, MD (Principal Investigator)
01/01/11–12/31/15
“Hypermethylation as a MicrobiomeGeorge Miller, MD (Principal Investigator)
DoD - Peer Reviewed
Mediated Epigenetic Phenomenon
“Dendritic cells link chronic pancreatitis to
Medical Research Program (PRMRP)
in CIMP(+) Colorectal Cancers”
pancreatic carcinoma”
09/01/12–08/31/15
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,
Rivera R, Hopkins MA, Triola M, Grossman RI. A 3-year M.D.—accelerating
careers, diminishing debt. N Engl J Med. 2013;369(12):1085-1087.
David A, Langnas E, Teperman C, Gelb B, Morgan G, Teperman L. PTC taste
status and TAS2R38 genotype as a possible indicator for alcohol use in liver
transplant patients. Am J Transplant. 2013;13(S5):221.
Alloway RR, Eckhoff DE, Washburn WK, Teperman LW. Conversion from twice
daily tacrolimus capsules to once daily extended-release tacrolimus
(LCP-Tacro): phase 2 trial of stable liver transplant recipients. Liver Transpl.
2014;20(5):564-575.
Feld JJ, Kowdley KV, Coakley E, Sigal S, Nelson DR, Crawford D, Weiland O,
Aguilar H, Xiong J, Pilot-Matias T, DaSilva-Tillmann B, Larsen L, Podsadecki T,
Bernstein B. Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with
ribavirin. N Engl J Med. 2014;370(17):1594-1603.
Asrani SK, Wiesner RH, Trotter JF, Klintmalm G, Katz E, Maller E, Roberts J,
Kneteman N, Teperman L, Fung JJ, Millis JM. De novo sirolimus and
reduced-dose tacrolimus versus standard-dose tacrolimus after liver
transplantation: the 2000-2003 phase II prospective randomized trial. Am J
Transplant. 2014;14(2):356-366.
Gelb B, Layman R, Teperman L. Telaprevir based combination therapy for the
treatment of recurrent HCV in liver transplant recipients: promising early
results late disappointment. Am J Transplant. 2013;13(S5):347.
Bernstein MA, Purdy CH, Becker A, Magar R. Three-year cost-effectiveness
model for non-animal stabilized hyaluronic acid and dextranomer copolymer
compared with sacral nerve stimulation after conservative therapy for the
management of fecal incontinence. Clin Ther. 2014;36(6):890-905.e3.
Charlton MR, Gane EJ, Manns MP, Brown RS, Curry MP, Kwo PY, Fontana RJ,
Gilroy R, Teperman LW, Muir AJ, McHutchison JG, Symonds WT, Denning JM,
McNair L, Arterburn S, Terrault N, Samuel D, Forns X. Sofosbuvir and ribavirin
for the treatment of established recurrent hepatitis C infection after liver
transplantation: preliminary results of a prospective, multicenter study.
Hepatology. 2013;58(6):1378A.
Glass N, Pinna A, Masi A, Rosman AS, Neihaus D, Okochi S, Saunders JK,
Hatzaras I, Cohen S, Berman S, Pachter HL, Newman E, Gouge TH, Melis M.
The surgical Apgar score is associated with the need for post-operative ICU
admission. [published online January 19, 2015]. J Gastrointest Surg.
Grodstein E, Gelb B, Layman R, Mittal R, Teperman L. Nucleoside reverse
transcriptase inhibitors without HBIG can be safely and cost-effectively
administered to prevent recurrent hepatitis B viremia post-liver transplant.
Am J Transplant. 2013;13(S5):352.
Gurvits GE, Marsano J, Kobrinsky B, Shin S, Sanfilippo N, Volkov D. Novel use
of endoscopically placed fiducial markers for targeted radiation therapy of
colonic lymphomas. Ann Gastroenterol. 2014;27(4):421-423.
Cho I, Yamanishi S, Cox L, Methé BA, Zavadil J, Li K, Gao Z, Mahana D, Raju K,
Teitler I, Li H, Alekseyenko AV, Blaser MJ. Antibiotics in early life alter the
murine colonic microbiome and adiposity. Nature. 2012;488(7413):621-626.
Hasan N, Gross SA, Gralnek IM, Pochapin M, Kiesslich R, Halpern Z. A novel
balloon colonoscope detects significantly more simulated polyps than a standard
colonoscope in a colon model. Gastrointest Endosc. 2014 Dec;80(6):1135-1140.
Chua DL, Hahambis T, Sigal SH. New-onset ascites as a manifestation of
virologic relapse in patients with hepatitis C cirrhosis. Hepat Med. 2014;6:11-14.
Hatzaras I, Sachs TE, Weiss M, Wolfgang CL, Pawlik TM.
Pancreaticoduodenectomy after bariatric surgery: challenges and available
techniques for reconstruction. J Gastrointest Surg. 2014;18(4):869-877.
Clutter DS, Dubrovskaya Y, Merl MY, Teperman L, Press R, Safdar A.
Fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid
organ and hematopoietic stem cell transplantation with Clostridium difficileassociated diarrhea. Antimicrob Agents Chemother. 2013;57(9):4501-4505.
Cohen SM, Nguyen AH, Pachter HL. Acute pancreatitis. In: Moore LJ, Turner
KL, Todd SR, eds. Common Problems in Acute Care Surgery. New York, NY:
Springer; 2013:303-316.
Collins A, Hatzaras I, Schmidt C, Carruthers K, Melvin WS, Muscarella P,
Ellison EC, Martin E, Bloomston M. Gastrectomy in advanced gastric cancer
effectively palliates symptoms and may improve survival in select patients. J
Gastrointest Surg. 2014;18(3):491-496.
Court H, Amoyel M, Hackman M, Lee KE, Xu R, Miller G, Bar-Sagi D, Bach EA,
Bergo MO, Philips MR. Isoprenylcysteine carboxylmethyltransferase
deficiency exacerbates KRAS-driven pancreatic neoplasia via Notch
suppression. J Clin Invest. 2013;123(11):4681-4694.
Cox LM, Yamanishi S, Sohn J, Alekseyenko AV, Leung JM, Cho I, Kim SG, Li H,
Gao Z, Mahana D, Zarate Rodriguez JG, Rogers AB, Robine N, Loke P, Blaser
MJ. Altering the intestinal microbiota during a critical developmental window
has lasting metabolic consequences. Cell. 2014;158(4):705-721.
Henning JR, Graffeo CS, Rehman A, Fallon NC, Zambirinis CP, Ochi A, Barilla
R, Jamal M, Deutsch M, Greco S, Ego-Osuala M, Bin-Saeed U, Rao RS, Badar S,
Quesada JP, Acehan D, Miller G. Dendritic cells limit fibroinflammatory injury
in nonalcoholic steatohepatitis in mice. Hepatology. 2013;58(2):589-602.
Hochberg MS, Berman RS, Kalet AL, Zabar SR, Gillespie C, Pachter HL. The
stress of residency: recognizing the signs of depression and suicide in you and
your fellow residents. Am J Surg. 2013;205(2):141-146.
Hochberg MS, Billig J, Berman RS, Kalet AL, Zabar SR, Fox JR, Pachter HL.
When surgeons decide to become surgeons: new opportunities for surgical
education. Am J Surg. 2014;207(2):194-200.
Jacobs RE, Bai S, Hindman N, Shah PC. Carcinoid abdominal crisis: a case
report. J Surg Oncol. 2014;110(3):348-351.
Katz S, Surawicz C, Pardi DS. Management of the elderly patients with
inflammatory bowel disease: practical considerations. Inflamm Bowel Dis.
2013;19(10):2257-2272.
Khan A, Serouya S, Poles MA, Traube M, Halahalli Srinivasa VM, Chen CT,
Yang L, Pei Z, Francois F. A burning issue: defining GERD in non-erosive
disease. Gastroenterology. 2013;144(5 suppl 1):S851.
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
Lee SC, Tang MS, Lim YA, Choy SH, Kurtz ZD, Cox LM, Gundra UM, Cho I,
Bonneau R, Blaser MJ, Chua KH, Loke P. Helminth colonization is associated with
increased diversity of the gut microbiota. PLoS Negl Trop Dis. 2014;8(5):e2880.
Leung JM, Davenport M, Wolff MJ, Wiens KE, Abidi WM, Poles MA, Cho I,
Ullman T, Mayer L, Loke P. IL-22-producing CD4+ cells are depleted in actively
inflamed colitis tissue. Mucosal Immunol. 2014;7(1):124-133.
Lin IH, Wu J, Cohen SM, Chen C, Bryk D, Marr M, Melis M, Newman E, Pachter
HL, Alekseyenko AV, Hayes RB, Ahn J. Pilot study of oral microbiome and risk
of pancreatic cancer. Cancer Research. 2013;73(8 suppl).
Lucey MR, Terrault N, Ojo L, Hay JE, Neuberger J, Blumberg E, Teperman LW.
Long-term management of the successful adult liver transplant: 2012 practice
guideline by the American Association for the Study of Liver Diseases and the
American Society of Transplantation. Liver Transpl. 2013;19(1):3-26.
Melis M, Pinna A, Marcon F, Miller G, Cohen SM, Pachter H, Newman E.
Lymph node ratio and survival after resection of pancreatic adenocarcinoma.
J Surg Res. 2013;179(2):194.
Melis M, Pinna A, Marcon F, Miller G, Cohen SM, Pachter H, Newman E.
Pancreaticoduodenectomy with portal vein resection for pancreatic
adenocarcinoma: a 10-year experience. J Surg Res. 2013;179(2):194.
Melis M, Pinna A, Okochi S, Masi A, Rosman AS, Neihaus D, Saunders JK,
Newman E, Gouge TH. Validation of the Surgical Apgar Score in a veteran
population undergoing general surgery. J Am Coll Surg. 2014;218(2):218-225.
Melis M, Rosen G, Hajdu CH, Pachter HL, Raccuia JS. Primary
rhabdomyosarcoma of the diaphragm: case report and review of the literature.
J Gastrointest Surg. 2013;17(4);799-804.
Mellgren A, Matzel K, Pollack J, Hull T, Bernstein MA, Graf W. Long term
efficacy of NASHA Dx injection therapy (Solesta) for treatment of fecal
incontinence. Neurogastroenterol Motil. 2014 Aug;26(8).
Merola J, Chaudhary N, Jow A, Charles HW, Teperman L, Sigal S. TIPS creation
is tolerated by patients with portal vein thrombosis with high MELD scores. J
Hepatol. 2013;58(suppl 1):S94.
Parikh M, Chung M, Sheth S, McMacken M, Zahra T, Saunders JK, Ude-Welcome A,
Dunn V, Ogedegbe G, Schmidt AM, Pachter HL. Randomized pilot trial of bariatric
surgery versus intensive medical weight management on diabetes remission in
type 2 diabetic patients who do NOT meet NIH criteria for surgery and the role of
soluble RAGE as a novel biomarker of success. Ann Surg. 2014;260(4):617-622.
Parikh M, Issa R, Vieira D, McMacken M, Saunders JK, Ude-Welcome A,
Schubart U, Ogedegbe G, Pachter HL. Role of bariatric surgery as treatment for
type 2 diabetes in patients who do not meet current NIH criteria: a systematic
review and meta-analysis. J Am Coll Surg. 2013;217(3):527-532.
Ramkhelawon B, Hennessy EJ, Ménager M, Ray TD, Sheedy FJ, Hutchison S,
Wanschel A, Oldebeken S, Geoffrion M, Spiro W, Miller G, McPherson R,
Rayner KJ, Moore KJ. Netrin-1 promotes adipose tissue macrophage retention
and insulin resistance in obesity. Nat Med. 2014;20(4):377-384.
PAGE 27
Rao R, Graffeo CS, Gulati R, Jamal M, Narayan S, Zambirinis CP, Barilla R,
Deutsch M, Greco S, Ochi A, Tomkotter L, Blobstein R, Avanzi A, Tippens DM,
Gelbstein Y, Van Heerden E, Miller G. Interleukin 17-producing γδT cells
promote hepatic regeneration in mice. Gastroenterology. 2014;147(2):473-484.e2.
Rao RS, Graffeo CS, Gulati R, Narayan S, Mohaimin T, Greco S, Tomkoetter L,
van Heerden E, Barilla RM, Carazas O, Blobstein R, Gelbstein Y, Ochi A,
Zambirinis CP, Deutsch M, Miller G. γδT cells promote liver regeneration via
Dectin-1 dependent IL-17/IL-22 mediated inflammatory interplay. Hepatology.
2013;58(S1):311A.
Razavi F, Gross S, Katz S. Endoscopy in the elderly: risks, benefits, and yield of
common endoscopic procedures. Clin Geriatr Med. 2014;30(1):133-147.
Rehman A, Hemmert KC, Ochi A, Jamal M, Henning JR, Barilla R, Quesada JP,
Zambirinis CP, Tang K, Ego-Osuala M, Rao RS, Greco S, Deutsch M, Narayan S,
Pachter HL, Graffeo CS, Acehan D, Miller G. Role of fatty-acid synthesis in
dendritic cell generation and function. J Immunol. 2013;190(9):4640-4649.
Rielland M, Cantor DJ, Graveline R, Hajdu C, Mara L, de Diego Diaz B, Miller G,
David G. Senescence-associated SIN3B promotes inflammation and
pancreatic cancer progression. J Clin Invest. 2014;124(5):2125-2135.
Roslin MS, Dudiy Y, Brownlee A, Weiskopf J, Shah P. Response to glucose
tolerance testing and solid high carbohydrate challenge: comparison between
Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch.
Surg Endosc. 2014;28(1):91-99.
Roslin MS, Oren JH, Polan BN, Damani T, Brauner R, Shah PC. Abnormal glucose
tolerance testing after gastric bypass. Surg Obes Relat Dis. 2013;9(1):26-31.
Safdar A, Tulliano G, Teperman L, Press R. Enterococcal colonization and disease in
solid-organ versus hematologic malignancy and hematopoietic stem cell
transplantation units (2000–2011). Am J Transplant. 2013;13(S5):344.
Zambirinis CP, Barilla R, Ego-Osuala M, Blobstein R, Avanzi A, Markowitz J,
Greco S, Deutsch M, Rao RS, Miller G. Gamma delta T cells regulate
pancreatitis. J Am Coll Surg. 2013;217(3 suppl):S17-S18.
Zambirinis CP, Miller G. Signaling via MYD88 in the pancreatic tumor
microenvironment: a double-edged sword. OncoImmunology.
2013;2(1):e22567.
Zambirinis CP, Pushalkar S, Saxena D, Miller G. Pancreatic cancer,
inflammation, and microbiome. Cancer J. 2014 May-Jun;20(3):195-202.
Zambirinis CP, Pushalkar S, Saxena D, Miller G. Pancreatic cancer,
inflammation, and microbiome. Cancer J. 2014;20(3):195-202.
PAGE 28
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
LOCATIONS
1 NYU Langone Gastroenterology
Ambulatory Care Center,
240 East 38th Street, New York, NY
6 additional
locations in
Westchester
NY
NYU Langone Hepatology
530 First Avenue, Suite 4J, New York, NY
2
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
160 East 34th Street, Ninth Floor, New York, NY
NJ
4
Joan H. Tisch Center for Women’s Health
207 East 84th Street, New York, NY
BRONX
5 Preston Robert Tisch Center
for Men’s Health
555 Madison Avenue, Second Floor, New York, NY
MANHATTAN
4
11
5
6 NYU Langone at Trinity Center
111 Broadway, Second Floor, New York, NY
7
9
3
12
8
1
10
2
6
NYU Langone Ambulatory Care Center West Side
355 West 52nd Street, Sixth Floor, New York, NY
7
QUEENS
NYU Langone Transplant
403 East 34th Street, Third Floor, New York, NY
8
BROOKLYN
13
9 NYU Langone East 35th Street
245 East 35th Street, New York, NY
NYU Langone at Columbus Medical
97-85 Queens Boulevard, Rego Park, NY
STATEN
ISLAND
14
10 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
Gastroenterology and GI Surgery
NYU Langone Medical Center
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
Chair of the Department of Surgery
Sholtz/Leeds Professor of Gastroenterology
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
Director, Colon and Rectal Surgery
ILSEUNG CHO, MD
JAMES S. PARK, MD
Assistant Professor of Medicine
Master Scholars Career Advisor
GI SURGERY
FRITZ FRANÇOIS, MD
Assistant Professor of Medicine
Co-Director, Transplant Hepatology
Director, Asian Liver Disease Program
RUSSELL S. BERMAN, MD
Associate Professor of Surgery
Director, General Surgery Residency Program
Director, Surgical Oncology
GEORGE MILLER, MD
Associate Professor of Surgery and Cell Biology
Vice Chair of Surgical Research
ELLIOT NEWMAN, MD
Professor, Surgery
Director, GI Surgical Oncology
H. LEON PACHTER, MD
George David Stewart Professor of Surgery
Chair of the Department of Surgery
PARESH C. SHAH, MD
Professor of Surgery
Director, General Surgery
Vice Chair of Quality and Innovation
TRANSPLANTATION
LEWIS W. TEPERMAN, MD
Associate Professor of Surgery
Director, Transplantation
Associate Professor of Medicine
Chief of Medicine, Tisch Hospital
ADAM J. GOODMAN, MD
Assistant Professor of Medicine
Director of Endoscopy, Bellevue Hospital Center
Associate Co-Director,
Gastroenterology Fellowship Program
SETH A. GROSS, MD
Associate Professor of Medicine
Gastroenterology Section Chief,
Tisch Hospital
Director of Endoscopy, Tisch Hospital
DAVID P. HUDESMAN, MD
Assistant Professor of Medicine
Director, Inflammatory Bowel Disease Program,
Tisch Hospital
SEYMOUR KATZ, MD
Sholtz/Leeds Professor of Gastroenterology
Professor of Medicine
Director, Division of Gastroenterology
MICHAEL A. POLES, MD, PhD
Associate Professor of Medicine,
Microbiology, and Pathology
Gastroenterology Section Chief,
VA NY Harbor Healthcare System – Manhattan
Director, Gastroenterology Fellowship Program
SAMUEL H. SIGAL, MD
Associate Professor of Medicine and Surgery
Clinical Director, Hepatology
Co-Director, Transplant Hepatology
HILLEL TOBIAS, MD, PhD
Clinical Professor of Medicine and Surgery
Medical Director, Liver Transplant
Clinical Professor of Medicine
Associate Director,
Inflammatory Bowel Disease Program
MORRIS TRAUBE, MD, JD
ABRAHAM R. KHAN, MD
GERALD A. VILLANUEVA, MD
Assistant Professor of Medicine
Associate Director,
Center for Esophageal Disease
Associate Co-Director,
Gastroenterology Fellowship Program
LISA B. MALTER, MD
Assistant Professor of Medicine
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
New York, NY 10016
212.263.7669
Ambulatory Care Center
[email protected]
MARK B. POCHAPIN, MD
240 East 38th Street 23rd Floor
New York, NY 10016
646.501.2322
[email protected]
For more information about our expert physicians, visit nyulmc.org
Professor of Medicine
Director, Center for Esophageal Disease
Clinical Associate Professor of Medicine
Gastroenterology Section Chief,
Bellevue Hospital Center
ELIZABETH H. WEINSHEL, MD
Professor of Medicine
Director, Gastroenterology Faculty Development,
Mentorship, and Leadership Program
NYU LANGONE MEDICAL CENTER / GASTROENTEROLOGY AND GI SURGERY / 2014
PAGE 30
LEADERSHIP
NEW YORK UNIVERSITY
NYU LANGONE MEDICAL CENTER
MARTIN LIPTON, Esq.
KENNETH G. LANGONE
JOHN SEXTON
ROBERT I. GROSSMAN, MD
Chair, Board of Trustees
Chair, Board of Trustees
President
Saul J. Farber Dean and
Chief Executive Officer
ROBERT BERNE, MBA, PhD
STEVEN B. ABRAMSON, MD
Executive Vice President for Health
Senior Vice President and Vice Dean
for Education, Faculty and Academic Affairs
DAFNA BAR-SAGI, PhD
Senior Vice President and Vice Dean
for Science, Chief Scientific Officer
BERNARD A. BIRNBAUM, MD
Senior Vice President and Vice Dean,
Chief of Hospital Operations
ANDREW W. BROTMAN, MD
ANNETTE JOHNSON, JD, PhD
Senior Vice President and Vice Dean,
General Counsel
GRACE Y. KO
Senior Vice President for
Development and Alumni Affairs
KATHY LEWIS
Senior Vice President for
Communications and Marketing
JOSEPH LHOTA
Senior Vice President and
Vice Dean, Chief of Staff
VICKI MATCH SUNA, AIA
Senior Vice President and Vice Dean
for Real Estate Development and Facilities
Senior Vice President and Vice Dean
for Clinical Affairs and Strategy,
Chief Clinical Officer
NADER MHERABI
MICHAEL T. BURKE
NANCY SANCHEZ
Senior Vice President and Vice Dean,
Corporate Chief Financial Officer
RICHARD DONOGHUE
Senior Vice President and Vice Dean,
Chief Information Officer
Senior Vice President and Vice Dean
for Human Resources and Organizational
Development and Learning
Senior Vice President for Strategy,
Planning and Business Development
NYU LANGONE MEDICAL CENTER
by the numbers*
1,069
1,408
4,000+
650
77
1,047
550,000
70
35,666
2,500+
$245MM
252
1,061,552
120
Endowed Professorships
Total Grant Funding
$285MM
415
5,422
2,515
2,053
1,155
2,000,000
2,953
936
Total Number of Beds
Operating Rooms
Patient Admissions
Hospital-Based Outpatient Visits
Births
Faculty Group Practice
Office Visits
Full-Time Faculty
Part-Time Faculty
Voluntary Faculty
Physicians
Registered and Advanced
Practice Nurses
550+
Publications
Square Feet of Research Space
NIH Funding
Inventions
US Patents Issued
475
US Patents Licensed
Allied Health Professionals
*Numbers represent FY14 (Sept 2013-Aug 2014); inventions/patents are cumulative through Aug 31, 2014
MD Candidates
MD/PhD Candidates
PhD Candidates
Postdoctoral Fellows
Residents and Fellows
CONTENTS
1 Message from Leadership
2 Facts & Figures
4 New & Noteworthy
10Microbiome
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
29 Leadership
Design: Craig Williams
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