- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04771247
Endoscopic Cardiac Band Ligation for the Management of Refractory GERD After Laparoscopic Sleeve Gastrectomy (CLEAR)
September 22, 2021 updated by: Johns Hopkins University
Endoscopic Cardiac Band Ligation (CLEAR) Without Sleeve Stenosis for the Management of Refractory GERD After Laparoscopic Sleeve Gastrectomy (LSG)
GERD is a prevalent condition worldwide, estimated to be around 20-30 % in North America.
Obesity is rapidly increasing with an estimated prevalence of 66% in the adult population in the United States.
Presently, bariatric interventions are the only sustainable method to address morbid obesity and its resulting comorbidities.
One of the most common restrictive surgeries includes laparoscopic sleeve gastrectomy (LSG).
Although very effective for treating obesity, some of these surgeries might cause deleterious effects regarding GERD, due to anatomical modifications.
Refractory GERD is defined by lack of symptom control on maximum dose of PPI therapy.
Cardia Band Ligation Anti-reflux (CLEAR) procedure utilizes multiple band ligations at the cardia in a 270-degree fashion, resulting in tissue necrosis and scar formation, narrowing the GE junction and enhancing the flap valve system.
The investigators hypothesized that CLEAR can be a safe and efficient intervention to improve post bariatric GERD.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Detailed Description
GERD is a prevalent condition worldwide, estimated to be around 20-30 % in North America.
Obesity is rapidly increasing with an estimated prevalence of 66% in the adult population in the United States.
GERD symptoms are common in the obese population with data showing weekly GERD symptoms in 34.6% and erosive esophagitis 26.9% in people with BMI > 30 Kg/m^2.
Reflux is associated with complications such as esophagitis, Barrett's Esophagus and ultimately esophageal adenocarcinoma.
Presently, bariatric interventions are the only sustainable method to address morbid obesity and its resulting comorbidities.
There are endoscopic and surgical bariatric interventions.
Bariatric surgery has been shown to be an effective and efficient means of achieving significant weight loss in obese individuals.
One of the most common restrictive surgeries includes laparoscopic sleeve gastrectomy (LSG).
Although very effective for treating obesity, some of these surgeries might cause deleterious effects regarding GERD, due to anatomical modifications.
LSG can increase the incidence of GERD, which may be explained from the changes in the angle of His and by increasing intragastric pressure.
Pharmacological therapy with proton pump inhibitors (PPI), H2 blockers and lifestyle changes are first line forms of treatment utilized to control the symptoms related to GERD.
However, patients who use pharmacological treatment experience reduction in quality of life and seek alternative options.
Refractory GERD is defined by lack of symptom control on maximum dose of PPI therapy.
Moreover, due to the anatomical changes associated with bariatric surgeries, the traditional surgical and endoscopic techniques (TIF, Nissen Fundoplication) used to treat GERD in the general population are not suitable for these patients.
With the current trend of an increase of bariatric surgery and thus GERD that arises after these surgeries, new innovative techniques to treat GERD are needed, especially in PPI averse or non-responsive patients.
Cardia Band Ligation Anti-reflux (CLEAR) procedure utilizes multiple band ligations at the cardia in a 270-degree fashion, resulting in tissue necrosis and scar formation, narrowing the GE junction and enhancing the flap valve system.
The investigators will perform CLEAR by placing 4 bands at the GEJ.
The investigators hypothesized that CLEAR can be a safe and efficient intervention to improve post bariatric GERD.
Study Type
Interventional
Phase
- Not Applicable
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 75 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Obese patients who underwent surgical bariatric weight loss procedures with post-surgical GERD (LSG), not responding to once daily PPI therapy.
- Obese patients who underwent surgical bariatric weight loss procedures with post-surgical GERD (LSG) who respond to maximum therapy with PPI + H2 blocker but are PPI averse or who refuse surgical therapy (conversion to RYGBP).
- Patients older than 18 years and younger than 75 years of age at time of consent.
- Patients able to provide written informed consent on the IRB/EC-approved informed consent form
- Patients willing and able to comply with study requirements for follow-up
Exclusion Criteria:
- Any patient with no prior surgical bariatric intervention.
- Pre-existing esophageal stenosis/stricture preventing advancement of an endoscope during screening/baseline EGD.
- Esophageal, gastric or duodenal malignancy.
- Severe medical comorbidities precluding endoscopy, or limiting life expectancy to less than 2 years in the judgment of the endoscopist.
- Uncontrolled coagulopathy or inability to be off anticoagulation or anti-platelet medication (ASA, Plavix) for 1 week prior to and 2 weeks after each endoscopy
- Active fungal esophagitis, Grade C or D esophagitis.
- Hiatal hernias > 2 cm or para-esophageal hernias.
- Known portal hypertension, visible esophageal or gastric varices, or history of esophageal varices.
- General poor health, multiple co-morbidities placing the patient at risk, or otherwise unsuitable for trial participation.
- Pregnant or planning to become pregnant during period of study participation.
- Patient refuses or is unable to provide written informed consent.
- Prior surgical or endoscopic anti-reflux procedure.
- Persistent dysphagia score greater than 0.
- Vomiting more than once a week.
- Biopsy-proven Barrett's esophagus.
- HREM showing marked ineffective esophageal motility (defined by ≥ 5 weak or failed swallows per Chicago Classification v 3.0), esophagogastric outflow obstruction (EGJOO) or achalasia.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: CLEAR
Patients with GERD post LSG will undergo CLEAR (cardia band ligation).
|
Patients will undergo cardia band ligation at the level of the GEJ.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in GERD-HQRL/RSI score
Time Frame: Baseline and 6 months
|
Change in symptoms assessed by GERD-HQRL/RSI score at 6 months.
|
Baseline and 6 months
|
Change in pH monitoring
Time Frame: Baseline and 6 months
|
Change in objective pH monitoring at 6 months.
|
Baseline and 6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean change on the percentage of acid exposure time (% AET)
Time Frame: Baseline and 6 months
|
Changes in acid exposure time from baseline.
|
Baseline and 6 months
|
Safety of CLEAR procedure as assessed by treatment-related adverse events
Time Frame: Up to 6 months
|
Assess overall safety (treatment-related adverse events) of CLEAR procedure defined by the ASGE-Lexicon classification.
|
Up to 6 months
|
Rate of dysphagia post CLEAR
Time Frame: 6-12 months
|
Percentage of patients who develop dysphagia of any grade, associated with esophageal or gastric cardia stricture requiring dilation after CLEAR procedure.
|
6-12 months
|
PPI discontinuation
Time Frame: 6 months
|
Percentage of patients who no longer require PPI at 6 months post CLEAR.
|
6 months
|
PPI discontinuation
Time Frame: 12 months
|
Percentage of patients who no longer require PPI at 12 months post CLEAR.
|
12 months
|
Treatment failure
Time Frame: 6 months
|
Defined as less than 50% improvement in GERD HQRL/RSI score or pH monitoring.
|
6 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Olaya I Brewer Gutierrez, Johns Hopkins University
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Anticipated)
September 1, 2021
Primary Completion (Anticipated)
September 1, 2021
Study Completion (Anticipated)
September 1, 2021
Study Registration Dates
First Submitted
February 23, 2021
First Submitted That Met QC Criteria
February 23, 2021
First Posted (Actual)
February 25, 2021
Study Record Updates
Last Update Posted (Actual)
September 28, 2021
Last Update Submitted That Met QC Criteria
September 22, 2021
Last Verified
September 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB00277820
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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