Transcription
Gastroenterology &GI Surgery2017 YEAR IN REVIEWDRAFT—1/17/201855638,000 LeadingIBD SURGERIESIN 13 MONTHSENDOSCOPYCASESPANCREATICRESEARCH
Contents1MESSAGE FROM LEADERSHIP2FACTS & FIGURES42017 IN BRIEF102017 IN DEPTH11Immunological and Molecular Clues Reveal New Insightsto Pancreatic Cancer14Bridging the Gap Between Bariatric Procedures andObesity-Related Complications16Renowned Specialists to Lead Liver Disease Programs18IBD: Expertise and Shared Decision Making OptimizePouch Surgery Selection Criteria20Closing the Racial Gap in Colorectal Cancer Screening22Community Outreach: Reaching Patients Where They Live23Colon Pathway Improves Elective Colon and Rectal SurgeryEfficiency and Patient Experience24ACADEMIC ACTIVITY27LEADERSHIPOn the cover: Colon cancer cells
MESSAGE FROM LEADERSHIPDear Colleaguesand Friends:We are delighted to share withyou this report on the recentachievements of NYU Langone’sDivision of Gastroenterology andDepartment of Surgery inaddressing benign and malignantgastrointestinal disease.We have added a number of renownedexperts to our multidisciplinary teamsand broken new ground in research andtreatment aimed at understanding andmore effectively treating complexesophageal, gastric, hepatic, pancreatic,intestinal, and colorectal diseases.Building on the already considerablestrengths of our teams, we were excitedto welcome pancreatic cancer surgeonand renowned researcher Diane M.Simeone, MD, the Laura and IsaacPerlmutter Professor of Surgery, professorof pathology, and associate director ofTranslational Research, as director of ournew Pancreatic Cancer Center. We werealso thrilled to welcome internationallyrenowned liver specialist Ira M.Jacobson, MD, who is widely respectedfor his groundbreaking research indeveloping antiviral therapies, asprofessor of medicine and director ofour hepatology program.Feza H. Remzi, MD—one of theworld’s foremost practitioners of pelvicpouch surgery, re-do pouch surgery, andreconstruction—was recruited last yearto lead the Inflammatory Bowel Disease(IBD) Center. In this report, we sharesome of Dr. Remzi’s research findings onrisk factors that affect clinical decisionsabout pouch surgery after colectomy.Dr. Remzi served as a course director,H. LEON PACHTER, MDMARK B. POCHAPIN, MDGeorge David StewartProfessor of SurgerySholtz/Leeds Professor ofGastroenterologyChair, Department ofSurgeryDirector, Division ofGastroenterologyVice Chair, Clinical AffairsDepartment of Medicinealong with David P. Hudesman, MD,and Lisa B. Malter, MD, for this year’sannual Big Gut Seminars: Focus onComplex IBD continuing medicaleducation course, featuring national IBDleaders and drawing attendees fromacross the country.Our bariatric surgery program, led byChristine J. Ren-Fielding, MD, continuesto advance the field in research andtreatment. Over the past year,investigators have delved into bariatricoutcomes in specific patient populations,including those with type 2 diabetes.Our faculty are also helping toincrease screening and access to carethrough national leadership andcommunity outreach initiatives. Forexample, as chair of the AmericanCollege of Gastroenterology (ACG)Committee on Minority Affairs andCultural Diversity, Renée L. Williams,MD, advocates for earlier screening andother strategies in an effort to decreasecolorectal cancer mortality rates amongAfrican Americans.On the education front, Gregory B.Haber, MD, served as a course directorof the advanced endoscopy live demo ofthe New York Society for GastrointestinalEndoscopy annual conference fromNYU Langone, and Abraham R.Khan, MD, hosted the live proceduredemo at NYU Langone for the AmericanNeurogastroenterology and MotilitySociety’s annual postgraduate course.In addition, the Division ofGastroenterology has expanded itsadvanced fellowship programs to includetwo advanced endoscopy fellows and atransplant hepatology fellow.The Department of Surgery’sinnovative professionalism curriculum,conceived and effectuated by Mark S.Hochberg, MD, Russell S. Berman, MD,and H. Leon Pachter, MD, has become anational model for surgical residencyprograms and has been incorporated intothe American Board of Surgery’s SCOREnational curriculum for residents. The“Gastroenterology Fellowship ProgramDirector’s Toolkit: Utilizing OSCEs toTeach and Evaluate Fellows’ Performance,”developed under the leadership ofElizabeth H. Weinshel, MD, incollaboration with the ACG, was featuredin a national ACG training webinar andis available on the ACG website.We are proud to collaborate withour colleagues nationwide to contributeto the advancement of scientificknowledge, the development of futurephysician leaders, and the provision ofadvanced, state-of-the-art clinical carefor patients with complex anddebilitating conditions.Gastroenterology & GI Surgery 2017 NYU Langone Health1
FACTS & FIGURESGastroenterology & GI SurgeryPATIENT CARERESEARCHEDUCATION38,000 9100%ENDOSCOPY CASES ANNUALLYPANCREATIC CANCERRESEARCHERS AT PERLMUTTERCANCER CENTEROF SURGICAL RESIDENTS194GASTROENTEROLOGISTS,HEPATOLOGISTS, ANDGI SURGEONSselected to lead and collaborate ina Cancer Interception TranslationalResearch Team by Stand Upto Cancer and the LustgartenFoundation for PancreaticCancer Researchincluding voluntary facultyperform clinical or scientific research440APPLICANTSfor four gastroenterologyfellowship slotsPERLMUTTER CANCER CENTER IS90%SUCCESS RATEfor referred re-operativepouch surgeriesperformed by Feza H. Remzi, MDSeptember 2016–October 20171 of 121,350NATIONAL SITESAPPLICANTSparticipating in the PancreaticCancer Action Network’sPrecision Promise, a large-scaleprecision medicine trialfor seven general surgeryresidency slotsNew47 ADVANCED FELLOWSHIPPROGRAMSOPEN CLINICAL TRIALSin transplant hepatology andadvanced endoscopyColon cancer cells2NYU Langone Health Gastroenterology & GI Surgery 2017
NYU Langone Health View of NYU Langone Health’s mainManhattan campus, including renderings ofthe new Science Building (left) and theHelen L. and Martin S. Kimmel Pavilion (right),both set to open in 2018.(Image credit: Ennead Architects)#19#12LeaderIN THE NATIONIN THE NATIONBEST MEDICAL SCHOOLSFOR RESEARCHIN QUALITY CARE ANDPATIENT SAFETYand nationally ranked in 12 specialties:Rehabilitation, Orthopedics,Rheumatology, Neurology &Neurosurgery, Geriatrics, Urology,Cardiology & Heart Surgery,Gastroenterology & GI Surgery,Diabetes & Endocrinology,Pulmonology, Cancer, and Nephrologyand a leader in innovation inmedical education, includingaccelerated pathways tothe MD degree5 Star RatingFROM CMS HOSPITAL COMPAREFor the past four years, NYU Langonehas received top rankings for overallpatient safety and quality of carefrom Vizient, Inc., formerly theUniversity HealthSystem Consortium.In 2017, NYU Langone receivedtwo significant awards from Vizient—the Bernard A. Birnbaum, MD,Quality Leadership Award andthe Ambulatory Care Quality andAccountability Award for demonstratedexcellence in delivering high-quality,patient-centered outpatient care.NYU Langone Health is the only full-service hospital in New York State and oneof 9 percent of hospitals nationwide to receive a five-star rating from the Centersfor Medicare and Medicaid Services (CMS). The rating reflects overall safety,quality, and patient experience.Gastroenterology & GI Surgery 2017 NYU Langone Health3
2017 IN BRIEFShifting Paradigms Enhance Patient Care,Research, and EducationA New Pancreatic CancerCenter Focusing on Researchand Early DetectionBuilding on a strong framework of collaboration,Perlmutter Cancer Center created a newmultidisciplinary Pancreatic Cancer Center in July2017. Renowned pancreatic cancer surgeon andresearcher Diane M. Simeone, MD, the Laura andIsaac Perlmutter Professor of Surgery, professor ofpathology, and associate director of TranslationalResearch, leads the combined effort, which leveragesinsights and expertise from across the institution.The centers are tackling long-standing questionsabout pancreatic cancer diagnosis, treatment, andprevention, and expanding on recent researchinsights into—and potential solutions to—pancreaticcancer’s ability to evade the immune system. Christine J. Ren-Fielding, MD, and Holly F. Lofton, MDWeight Management ProgramAccredited for Care of Adultsand AdolescentsNYU Langone’s Weight Management Program, whosesurgeons’ expertise in performing laparoscopic adjustablebanding makes them among the best in the nation, earnedaccreditation from the Metabolic and Bariatric SurgeryAccreditation and Quality Improvement Program (MBSAQIP).The Weight Management Program is now designated anMBSAQIP Accredited Center—Comprehensive withAdolescent Qualifications, as awarded by the AmericanCollege of Surgeons and the American Society for Metabolicand Bariatric Surgery. “With a commitment to optimizingquality outcomes and patient satisfaction, the program offerspatients a comprehensive approach to weight managementthat includes a variety of tailored surgical options,” saysGeorge A. Fielding, MD, the J. Ira and Nicki Harris FamilyProfessor of Surgery and Bariatric Medicine.4NYU Langone Health Gastroenterology & GI Surgery 2017Read more onPAGE 11New Insight into BariatricSurgery OutcomesResearch at NYU Langone has demonstrated thepotential long-term benefits of bariatric surgery forpatients who are unable to maintain weight lossthrough other methods. Over the past year,investigators have delved further into the risks andbenefits of different surgical techniques in specificpatient populations, including those with type 2diabetes. Christine J. Ren-Fielding, MD, professor ofsurgery and chief of the Division of Bariatric Surgery,reports on the impact of surgery on other factors suchas lipid profiles and knee osteoarthritis pain.Read more onPAGE 14
Research Suggests New Way to Treat Inflammatory Bowel Diseaseand Prevent Rejection of Bone Marrow TransplantsA new study, published online on October 31, 2017, in theJournal of Experimental Medicine, demonstrates thatATG16L1 in the intestinal epithelium is essential forpreventing loss of Paneth cells and exaggerated celldeath in animal models of virally triggeredInflammatory Bowel Disease (IBD) and allogeneichematopoietic stem cell transplantation. Intestinalorganoids lacking ATG16L1 reproduced this loss inPaneth cells and displayed tumor necrosis factor (TNF)alpha-mediated necroptosis, a form of programmed celldeath. Researchers at NYU School of Medicine andcollaborators found that in both applications, the druginfliximab (marketed as Remicade ) blocks thecontribution of the protein TNF alpha to problemcausing inflammation. TNF alpha increases the rush ofimmune cells to the site of an infection, where these cellsseek to destroy foreign invaders such as bacteria.However, these same inflammatory responses canbecome part of a disease if they mistakenly target thebody’s own cells, such as occurs in autoimmuneconditions like Crohn’s disease. The researchers found that infliximab preventsTNF alpha from speeding up the death of Paneth cells,which protect the gut from microbes. The team alsofound that the gene ATG16L1 kept TNF alpha–driveninflammation from triggering the destruction of anexcessive number of Paneth cells by an explosive processcalled necroptosis. “Our study results are the first toargue that we may be able to treat inflammatory boweldisease and protect against transplant-associateddisease not only by blocking TNF alpha as is donecurrently but also by stimulating ATG16L1 to preventthe early death of cells lining the gut,” says seniorinvestigator Ken H. Cadwell, PhD, associate professorof microbiology at NYU School of Medicine andNYU Langone Health’s Skirball Institute of BiomolecularMedicine. Dr. Cadwell cautions that this strategy mustawait further evidence to confirm the theory that thistrend in Paneth cell death occurs in people deficient inATG16L1, who are, like his animal models, prone tohigher risk of inflammatory disease and transplantassociated disease.Renowned Faculty BolsterLiver Disease ProgramsIra M. Jacobson, MDNYU Langone has recruited renowned experts inliver disease to enhance care for patients with liverand biliary diseases. Ira M. Jacobson, MD, professorof medicine, known globally for his groundbreakingwork in developing antiviral therapy for hepatitis,came on board as director of Hepatology inthe Department of Medicine’s Division ofGastroenterology. Theodore H. Welling, MD,associate professor of surgery, took the helm of thenewly launched multidisciplinary Liver TumorProgram at Perlmutter Cancer Center. Both expertswork closely with NYU Langone’s TransplantInstitute, where specialists provide advanced carefor patients with end-stage liver disease. TheTransplant Institute has also produced new researchon the state of living donor liver transplantation.Read more onPAGE 16Theodore H. Welling, MD (on left)Gastroenterology & GI Surgery 2017 NYU Langone Health5
Sharing Inflammatory Bowel Disease Expertise at the 2017 AIBD ConferenceNYU Langone researchers presented new research and ledkey discussions at the 2017 Advances in Inflammatory BowelDiseases Conference in Orlando. Conference topics rangedfrom the importance of collaborative disease management toemerging data on readmission after pouch surgery andtreating postoperative ileus. A study by postdoctoral researchfellow H. Hande Aydinli, MD, and Feza H. Remzi, MD,professor of surgery and director of the Inflammatory BowelDisease (IBD) Center, found that surgical site infections (SSIs)are a leading reason nationally for readmission following ilealpouch anal anastomosis (IPAA) for medically refractoryulcerative colitis. Analysis of three years of American Collegeof Surgeons National Surgical Quality Improvement Programdata revealed that a fifth of patients were readmitted within30 days of IPAA. To improve outcomes, measures aimed atimproving SSI rates and reducing postoperative dehydrationshould be considered.NYU Langone researchers, led by Shannon Chang, MD,assistant professor of medicine, also presented findings on theuse of alvimopan in patients with IBD as prophylaxis againstpostoperative ileus after bowel resection. IBD patientsundergoing bowel resection with the use of alvimopan werefound to have a significantly shorter length of stay whencompared to those who did not receive alvimopan.Gastrointestinal recovery time was significantly faster acrossthe board for patients receiving alvimopan.Several IBD faculty also led discussions in the conference’ssurgical and clinical tracks, including Dr. Remzi, David P.Hudesman, MD, associate professor of medicine and medicaldirector of the IBD Center,and Seymour Katz, MD,clinical professor ofmedicine and directorof the center’s IBDOutreach Programs.Lisa B. Malter, MD,associate professor ofmedicine and director ofthe Inflammatory BowelDisease Program at NYCHealth Hospitals/Bellevue, shared the impactof use of a multimodalSeymour Katz, MDeducational intervention toimprove healthcaremaintenance of IBDpatients in a gastroenterology fellow–managed setting in alarge urban medical center. After the intervention, the rateof healthcare maintenance measures addressed overallincreased from 37 percent to 52 percent (P .001). Theintervention yielded statistically significant findings forbone health, vaccinations, and therapy-specific measures.Dr. Remzi is known for tackling the most complexIBD cases and is a world leader in the performance of pouchsurgery. His team’s work and vision for the IBD Center arefeatured in the fall 2017 issue of NYU Langone HealthMagazine. The full article is available at nyulangone.org/publications.Selecting Patients forPouch SurgeryPouch surgery is often successful in experiencedhands, but the complex operation may not beappropriate for all patients. Feza H. Remzi, MD,professor of surgery, recently co-wrote a study led byShannon Chang, MD, assistant professor of medicine,examining several diseases and characteristics thatmay put patients at higher risk of postoperative pouchdysfunction or failure. Using an aggressive butreasoned approach to patient selection, however,the team at NYU Langone has been able to expandthe pool of eligible patients. Feza H. Remzi, MD, and H. Leon Pachter, MD6Read more onPAGE 18NYU Langone Health Gastroenterology & GI Surgery 2017
Continuing Medical Education Courseson Complex Inflammatory Bowel Disease,Pancreatic Disease, and Liver DiseaseMARCH 9, 2018NOVEMBER 30, 2018Big Gut Seminars:Focus on ComplexInflammatory Bowel DiseaseBig Gut Seminars: Focus onComplex Liver Diseases ourse directors:CDavid P. Hudesman, MDLisa B. Malter, MDFeza H. Remzi, MD ourse directors:CNabil N. Dagher, MDIra M. Jacobson, MDGeorge Miller, MDJames S. Park, MDHillel Tobias, MD, PhDSEPTEMBER 28, 2018Big Gut Seminars: Focus onComplex Pancreatic Diseases or more information, visitFnyulmc.org/cme. ourse directors:CSeth A. Gross, MDGregory B. Haber, MDElliot Newman, MDParesh C. Shah, MDDiane M. Simeone, MDLisa B. Malter, MDClosing the Racial Gap: RenewedFocus on African Americans andRecommendation for EarlierColorectal Cancer ScreeningAlthough increased screening, treatment advances,and other factors have resulted in reduced colorectalcancer (CRC) incidence and mortality among AfricanAmericans, significant racial disparities persist. Theremaining differences in incidence and mortalityhave led many organizations to look at factors—including age at diagnosis and age at first screening—that may be contributing to these disparities. Renée L.Williams, MD, assistant professor of medicine andchair of the American College of GastroenterologyCommittee on Minority Affairs and CulturalDiversity, offers a perspective on recommendationsthat CRC screening for African Americans beginat age 45 rather than at age 50, the currentrecommendation for average-risk individuals.Read more onPAGE 20Seth A. Gross, MDSharingExpertiseNYU Langone faculty providestate-of-the-art expertise in allareas of gastrointestinal care, withspecialized clinical, educational,and research programs in advancedand therapeutic endoscopy,inflammatory bowel disease, liverdisease, pancreatic cancer,esophageal disease, and colorectalcancer screening and prevention.Elliot Newman, MDParesh C. Shah, MDGastroenterology & GI Surgery 2017 NYU Langone Health7
Demonstrating Expertise ThroughLive Endoscopy CasesExperts from our Divisions of Gastroenterology andGI Surgery hosted several live-streamed events fromNYU Langone this past year, including:Live demonstration of manometry and other highlyspecialized procedures as part of the AmericanNeurogastroenterology and Motility Society’s annualcourse, held on August 4–6, 2017. Abraham R. Khan, MD,assistant professor of medicine and director of the Centerfor Esophageal Disease, hosted the demonstration.Pathway Improves Elective Colonand Rectal Surgery Efficiency andPatient ExperienceIn the Division of Colorectal Surgery, evidence-basedplans of care for all patients undergoing elective colonand rectal surgery come in the form of the ColonPathway, a tool fully integrated into NYU LangoneHealth’s electronic health record (EHR) system.Read more onPAGE 23Precision Endoscopy: The Scope of the Future, theNew York Society for Gastrointestinal Endoscopy’s 41stAnnual New York Course, held on December 14–15, 2017.Gregory B. Haber, MD, professor of medicine, chief ofEndoscopy, and director of Advanced Therapeutics andInnovation, was one of the two live endoscopy coursedirectors. Brian P. Bosworth, MD, professor of medicine,Jonathan Cohen, MD, clinical professor of medicine, andAdam J. Goodman, MD, associate professor of medicine,were the annual course consultants.Alexis L. Grucela, MDAdvancedFellowshipsPROGRAM EXPANSIONGregory B. Haber, MDAbraham R. Khan, MDUnder the new leadership of Gregory B.Haber, MD, professor of medicine, and IraM. Jacobson, MD, professor of medicine,we have launched and expanded ouradvanced fellowship programs this year.Sonja K. Olsen, MD, clinical assistantprofessor of medicine, has been
New Insight into Bariatric Surgery Outcomes Research at NYU Langone has demonstrated the potential long-term benefits of bariatric surgery for patients who are unable to maintain weight loss through other methods. Over the past year, investigators have delved further into the risks and benefits of different surgical techniques in specific
