- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01275768
Role of Endoscopic RFA in Prolonging the Patency of Metal Stents in Patients With Malignant Obstructive Jaundice
A Double Blind, Randomized Controlled Prospective Trial of Endo-biliary Radio-frequency Ablation for Maintenance of Metal Stent Patency in Patients With Malignant Obstructive Jaundice
Study Overview
Status
Intervention / Treatment
Detailed Description
We assume that application of endobiliary RFA to the malignant stricture which results in considerable charring of the tumor would result in prolongation of Self-expandable metal Stent (SEMS) patency by decreasing tumor in-growth and overgrowth. It is further speculated that prolonged stent patency will improve the quality of life of these patients, prevent cholangitis and optimize chemotherapy. A further outcome may be an improvement in the survival.
The research questions which we intend to answer through this trial would be:
- Does application of prior endo-biliary radiofrequency affect patency of SEMS?
- What are the complications associated with the use of endo-biliary RFA?
- Does endo-biliary RFA with immediate placement of SEMS improve patient survival?
- Is there any improvement in the quality of life of the patient with the combined use of endo-biliary RFA and SEMS?
Study protocol:
The study design is a double blind, sham operated, randomized controlled trial.
Inclusion criteria:
- Patients: Clinical data and investigations suggestive of unresectable malignant bile duct obstruction. All patients will be discussed at the hepato-biliary multidisciplinary meeting which should come to a unanimous decision on tumor unresectability.
- Age more than 18 years
- Histologically/ Cytologically confirmed malignancy
- Informed consent: The patient should voluntarily agree to participation and randomization. Oral and written information about the nature of the trial will be given to all patients considered for inclusion.
Exclusion Criteria:
- Informed consent not obtained or withdrawn
- Extremely poor general condition not amenable for conscious sedation used for Endoscopic retrograde Cholangiography (ERC)
- Candidate suitable for surgical resection
- Klatskin type 4 tumor
- Previous biliary intervention such as plastic stent insertion for more than 1 month
- Any other contra-indication to ERC
Randomization:
After obtaining an informed consent and satisfying the inclusion criteria, the patients will be randomized to one of the following two arms using computer generated randomization blocks. The operator and the patient will be blinded to use of RFA
- Experimental arm: Insertion and activation of the endo-biliary RF catheter at the site of the stricture before insertion of a SEMS
- Control arm: Insertion and sham activation of the endo-biliary RF catheter at the site of the stricture before insertion of a SEMS.
All patients will get the same SEMS with variable lengths (depending on the stricture size) to maintain uniformity. Endoscopic sphincterotomy will be performed in all patients prior to endo-biliary RF application and SEMS insertion. Opacification of the cystic duct and whether the endo-biliary RFA catheter was placed at the cystic duct opening will be recorded.
Data Collection:
Baseline data will be collected by an advanced endoscopy fellow and will include age, gender, WHO performance score, presence of gall bladder or gall stones, primary tumor type and stage, baseline liver function test, adjuvant chemo/radiotherapy
After discharge from the hospital, the patients will be followed up in the clinic at 1 week, 1 month, 3 months, 6 months, 9 months and 12 months. At each visit, a detailed clinical history, examination, adverse events, adjuvant therapy and liver function tests will be carried out. Patients will be assessed according to the World Health Organization performance classification.
WHO score
- 0 - Asymptomatic (Fully active, able to carry on all predisease activities without restriction)
- 1 - Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work)
- 2 - Symptomatic, <50% in bed during the day (Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours)
- 3 - Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours)
- 4 - Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair)
- 5 - Death All patients will be referred for an oncological opinion for palliative chemotherapy. The patients and their care-givers will be told about symptoms of cholangitis and stent obstruction and will be asked to contact the hospital immediately in such cases. In the event of a confirmed SEMS occlusion, either a new SEMS or a plastic stent will be placed depending on the patient's prognosis.
End points:
Stent occlusion:
- Cholangitis
- or serum bilirubin > 3mg/dL with a previously normal bilirubin or above the baseline.
- Any clinical jaundice should be confirmed as being caused by stent occlusion by imaging or ERC
- Death
- Uneventful follow-up for 12 months
Evaluation:
The primary aim will be to compare the two groups for duration of stent patency.
The secondary aims will be:
- To study any complications attributable to endo-biliary RFA
- To study if there is any improvement in patient survival
- To study if there is any improvement in patient's quality of life
Statistics:
We assume that the metal stent patency will improve from 50% to 80% at 6-8 months. With a 80% power and alpha error of 5%, we will need 43 patients in each arm. The Fisher exact test will be used to evaluate any differences in the patient distribution. The Student unpaired t test will be used to compare the laboratory tests, age and sex. Cumulative stent patency and patient survival will be estimated using the Kaplan-Meier method.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Locations
-
-
Andhra Pradesh
-
Hyderabad, Andhra Pradesh, India, 500 082
- D. Nageshwar Reddy
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients: Clinical data and investigations suggestive of unresectable malignant bile duct obstruction. All patients will be discussed at the hepato-biliary multidisciplinary meeting which should come to a unanimous decision on tumor unresectability.
- Age more than 18 years
- Histologically/ Cytologically confirmed malignancy
- Informed consent: The patient should voluntarily agree to participation and randomization. Oral and written information about the nature of the trial will be given to all patients considered for inclusion.
Exclusion Criteria:
- Informed consent not obtained or withdrawn
- Extremely poor general condition not amenable for conscious sedation used for ERC
- Candidate suitable for surgical resection
- Klatskin type 4 tumor
- Previous biliary intervention such as plastic stent insertion for more than 1 month
- Any other contra-indication to ERC
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: TRIPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Experimental arm
Insertion and activation of the endo-biliary RF catheter at the site of the stricture before insertion of a Self-expandable Metal Stent (SEMS)
|
Endobiliary radiofrequency catheter is 8Fr in diameter and can easily be passed over a 0.035 guide wire through the biopsy channel of a duodenoscope at the time of endoscopic retrograde cholangiography (ERC).
Its use in the biliary system was heralded by animal experiments following which power settings of 7-10 Watts for 2 minutes were found to provide adequate ablation.
The ablation results in charring of the tumor and this is expected to enhance the patency of SEMS
|
PLACEBO_COMPARATOR: Control arm
Insertion and sham activation of the endo-biliary RF catheter at the site of the stricture before insertion of a SEMS
|
Endobiliary radiofrequency catheter is 8Fr in diameter and can easily be passed over a 0.035 guide wire through the biopsy channel of a duodenoscope at the time of endoscopic retrograde cholangiography (ERC).
Its use in the biliary system was heralded by animal experiments following which power settings of 7-10 Watts for 2 minutes were found to provide adequate ablation.
The ablation results in charring of the tumor and this is expected to enhance the patency of SEMS
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to stent occlusion
Time Frame: 12 months
|
Defined by a. Cholangitis b. or serum bilirubin > 3mg/dL with a previously normal bilirubin or above the baseline. c. Any clinical jaundice should be confirmed as being caused by stent occlusion by imaging or ERC |
12 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Death
Time Frame: 12 months
|
12 months
|
Collaborators and Investigators
Investigators
- Study Director: D. Nageshwar Reddy, DM, Asian institute of Gastroenterology
Study record dates
Study Major Dates
Study Start
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- AIG-GI-201101
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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