EUS-guided Transenteric Drainage With a Novel Lumen-apposing Metal Stent

EUS-guided Transenteric Drainage With a Novel Lumen-apposing Metal Stent for the Management of Pancreato-biliary Diseases: a Multi-national, Multicenter Prospective Study

To evaluate clinical efficacy and safety of a novel lumen-apposing FCSEMS for EUS-guided transenteric drainage of PFC or of biliary tree including GB

Study Overview

• Status: Completed
• Conditions: Acute Cholecystitis; Pancreatic Pseudocyst; Biliary Obstruction; Pancreatic Necrosis
• Intervention / Treatment: Device: EUS-guided drainage

Detailed Description

Patients with the following conditions would be recruited for drainage under EUS guidance with the new lumen apposing FCSEMS

• Symptomatic or infected pancreatic pseudocyst or walled-off necrosis (WON) (SPAXUS 16 or 10 mm)
• Acute cholecystitis by inoperable malignant diseases (SPAXUS 10 mm)
• Acute cholecystitis by benign conditions with high-risk for operation (SPAXUS 10 mm)
• Long-term cholecystostomy at high-risk for operation (SPAXUS 10 mm)
• Symptomatic malignant obstruction of the distal CBD with unsuccessful transpapillary approach (the diameter of the CBD > 10 mm) (SPAXUS 8 or 10 mm)

Outcome paramaters include technical and clinical success, adverse events.

• Study Type: Interventional
• Enrollment (Actual): 114
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Hong Kong
    • Hong Kong, Hong Kong, China
      • Chinese University of Hong Kong

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Patient must meet all of the following inclusion criteria to be eligible for enrollment into the study.

• Pancreatobiliary diseases that are eligible for EUS-guided transenteric drainage
• The patient who aged from 20 to 80 years. Legally acceptable representative must be capable of giving written informed consent prior to participation in this study
• Target lesion that is accessible through the transenteric approach
• The woman of child-bearing age must be negative from the pregnancy test in order to participate in this study
• The patient who is willing and able to comply with the scheduled visits, treatment plan, laboratory tests, and other study procedures
• The patients should not have any unacceptable conditions (e.g., physiological, familyism, social, geographical) for medical follow-up and adaptation of the study.

Exclusion Criteria:

Patient presenting with any of the following will not be included in the study.

• Inaccessible to EUS-guided approach
• Bleeding tendency: International normalized ratio (INR) of prothrombin time < 1.5 or platelet conunt < 60,000/mm3
• Patients with Disseminated Intravascular Coagulation syndrome(DIC)
• Patients who have been taking medicines that can cause hemorrhage (e.g., Aspirin, Wafarin etc.)
• Patients with other serious disease or medical condition
• Patients with past medical history of significant neurologic or Psychiatric disorders such as dementia or seizure
• Unstable heart disease despite of treatment, recent myocardial infarction within 6 month (Even though MI was diagnosed within 6 months, if it becomes stable presently, the patient can be possible to participate).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: EUS guided drainage; Patients suffering from the conditions in focus would receive EUS guided drainage with the lumen apposing stent

Device: EUS-guided drainage; Ultrasonographic evaluation of the lesion by linear echoendoscope and positioning for transenteric puncture in shortest distance between enteric wall and the target lumen for drainage.; EUS-guided transenteric puncture by using a 19-gauge needle followed by placement of a 0.035 or 0.025-inch guidewire into the target lumen.; After the needle is removed in remaining the guidewire, the tract is dilated over the guidewire by using bougie dilator or needle type cystotome (Endoflex, Voerde, Germany). And then, the tract may be more dilated by using balloon catheter (4-mm).; After dilation of the tract, stent delivery system is inserted over the guidewire into the target lumen.; After complete deployment of the distal flange under EUS and fluoroscopic guidance into the target lumen, proximal retraction of the delivery system until the blue mark on the handle of the introducer is seen. And then, the proximal flange is deployed slowly under endoscopic guidance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical success for pancreatic fluid collections	① Clinical success of pancreatic fluid collections; Peudocyst: resolution more than 50% in the initial size of cyst.; Walled-off necrosis: resolution of PFC without the need for additional interventions after endoscopic interventions.	8 hrs
Clinical success for acute cholecystitis	- Afebrile for 8 hours, tolerating diet, absence of abdominal sign, or 20% decrease in white cell count.	8hrs
Clinical success for obstructive jaundice	- A decrease in total bilirubin to < 50 % of the pre-stenting value within 2 weeks.	2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Techincal success	- Satisfactory access, placement of stent and drainage.	1 day
Adverse events	Bleeding: any hemorrhagic event during or after the procedure that required endotherapy, radiological interventions, blood product transfusion, or inpatient observation.Perforation: perforation of the GI tract or cystic wall on imaging studies with peritonitis signs.Pneumoperitoneum or pneumoretroperitoneum: intraperitoneal or retroperitoneal air on imaging study.Stent migration: dislocation of the stent into the lumen or the GI tract on imaging study	30 day

Collaborators and Investigators

• Sponsor: Chinese University of Hong Kong
• Collaborators: SoonChunHyang University School of Medicine
• Investigators: Principal Investigator: Anthony Teoh, Chinese University of Hong Kong

Publications and helpful links

General Publications

• Teoh AYB, Kongkam P, Bapaye A, Ratanachu T, Reknimitr R, Lakthakia S, Chan SM, Gadhikar HP, Korrapati SK, Lee YN, Medarapalem J, Ridtitid W, Moon JH. Use of a novel lumen apposing metallic stent for drainage of the bile duct and gallbladder: Long term outcomes of a prospective international trial. Dig Endosc. 2021 Nov;33(7):1139-1145. doi: 10.1111/den.13911. Epub 2021 Jan 11.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2016
• Primary Completion (Actual): October 1, 2018
• Study Completion (Actual): May 1, 2019

Study Registration Dates

• First Submitted: December 16, 2016
• First Submitted That Met QC Criteria: December 20, 2016
• First Posted (Estimate): December 23, 2016

Study Record Updates

• Last Update Posted (Actual): December 13, 2019
• Last Update Submitted That Met QC Criteria: December 12, 2019
• Last Verified: December 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Neoplasms; Cysts; Gallbladder Diseases; Biliary Tract Diseases; Pancreatic Diseases; Pancreatitis; Pancreatic Cyst; Cholecystitis; Cholecystitis, Acute; Necrosis; Pancreatic Pseudocyst; Pancreatitis, Acute Necrotizing
• Other Study ID Numbers: SPAXUS version 3.0

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO