REvision of VSG with Ablation of the Mucosa Procedure (REVAMP)

The purpose of this study is to evaluate the feasibility, safety, and tolerability of endoscopic selective gastric mucosal ablation (GMA) using argon plasma coagulation after sleeve gastrectomy. In this study, GMA will be performed on patients who have experienced weight regain following an initial successful response to sleeve gastrectomy.

Study Overview

• Status: Recruiting
• Conditions: Obesity Prevention; Obesity Recidivism; Obesity and Overweight; Obesity and Obesity-related Medical Conditions
• Intervention / Treatment: Device: Gastric Mucosal Ablation (GMA)

Detailed Description

Obesity is a multifaceted chronic disease associated with substantial morbidity and mortality, leading to conditions like diabetes, cardiovascular diseases, and malignancies. Bariatric procedures, such as the sleeve gastrectomy, stand out as the current most effective long-term treatments for obesity. Despite its effectiveness, a significant number of patients experience weight regain during long-term follow-up. Endoscopic minimally invasive bariatric intervention has been proposed as a viable, safe, and effective option for the treatment of weight regain after SG. Gastric mucosal ablation (GMA), in particular, is hypothesized to be a safe and effective endoscopic revisional treatment for weight regain following sleeve gastrectomy based on previous positive pre-clinical and clinical studies. To investigate the feasibility, safety, and tolerability of GMA after sleeve gastrectomy, a single procedure is designed to ablate the gastric mucosa of the pseudo greater curvature created after the sleeve gastrectomy in a single endoscopic session. We hypothesize that endoscopic selective ablation of the gastric mucosa after sleeve gastrectomy is effective as a revisional treatment for weight regain and will result in significant metabolic improvements.

• Study Type: Interventional
• Enrollment (Estimated): 5
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Shannon Casey, MS; Phone Number: (919) 391-7843; Email: Shannon@trueyouweightloss.com
• Study Contact Backup: Name: Chase Wooley, BS; Phone Number: (984) 345-2988; Email: Chase@trueyouweightloss.com

Study Locations

• United States
  • North Carolina
    • Cary, North Carolina, United States, 27513
      • Recruiting
      • True You Weight Loss
      • Contact: Shannon Casey, MS; Phone Number: (919) 391-7843; Email: Shannon@trueyouweightloss.com
      • Contact: Chase Wooley, BS; Phone Number: (984) 345-2988; Email: Chase@trueyouweightloss.com
      • Contact: Christopher McGowan, MD, MSCR

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Male and female patients who have:

   1. BMI of 30 kg/m2 or greater, AND
   2. regained at least 25% of the total weight lost after initial successful response to sleeve gastrectomy. defined as Excess Weight Loss (EWL) greater than 50% or Total Body Weight Loss (TBWL) exceeding 20%
2. Must have undergone SG at least three years before the time of enrollment
3. Age range: 22 - 60 years
4. Must agree to refrain from using weight loss medications such as Meridia, Saxenda, Januvia, Xenical, Duromine, GLP-1 agonists (e.g., Ozempic, Wegovy) and dual GLP-1/GIP agonists (e.g., Mounjaro, Zepbound), as well as any over-the-counter weight loss medications or supplements throughout the study.
5. Women of childbearing potential (WOCBP) must agree to use acceptable contraception methods.
6. Must agree not to donate blood during participation in the study.
7. Should be able to comply with study requirements, understand, and sign the Informed Consent Form.
8. Stable weight defined as a fluctuation of less than 5% for at least 3 months prior to the screening visit.
9. Should have a history of failure to lose weight using conventional diet and lifestyle therapies.
10. Must have reliable access to wifi and/or internet services.
11. Must express willingness to comply with the substantial lifelong dietary restrictions required by the procedure.

Exclusion Criteria:

1. Inadequate response to sleeve gastrectomy
2. Patients requiring exogenous insulin.
3. HbA1c > 8.5%
4. Pregnant or breast-feeding or intending to get pregnant during the study.
5. Unwilling or unable to complete the Visual Analogue Scale for pain assessment, patient questionnaires, or comply with study visits and other study procedures as required per protocol.
6. History of diabetic ketoacidosis or hyperosmolar nonketotic coma.
7. Previous use of any types of insulin for > 1 month (at any time, except for treatment of gestational diabetes).
8. Change in diabetic treatment within the last three months.
9. Use of glucose-lowering drugs for diabetes mellitus treatment with the exception of sulfonylurea (SU), biguanides and sodium-dependent glucose co-transporter 2 (SGLT-2) inhibitors.
10. GLP-1 use in the preceding 6 months.
11. Known autoimmune disease, other than autoimmune thyroid disease, which is adequately replaced, including but not limited to celiac disease, or pre-existing symptoms of systemic lupus erythematosus, scleroderma or other autoimmune connective tissue disorder.
12. Previous endoscopic bariatric procedures or conditions, prior intra-gastric balloon or another gastric implant.
13. History of diabetic gastroparesis.
14. Known active hepatitis or active liver disease other than Non-Alcoholic Fatty Liver Disease or Non-Alcoholic Steatohepatitis.
15. Acute gastrointestinal illness in the previous 7 days.
16. Known history of irritable bowel syndrome, radiation enteritis, or other inflammatory bowel disease, such as Crohn's disease.
17. Known history of a structural or functional disorder of the esophagus that may impede passage of the device through the gastrointestinal tract or increase the risk of esophageal damage during an endoscopic procedure, including Barrett's esophagus, esophagitis, dysphagia, achalasia, stricture/stenosis, esophageal varices, esophageal diverticula, esophageal perforation, or any other disorder of the esophagus.
18. Known history of a structural or functional disorder of the esophagus, including any swallowing disorder, esophageal chest pain disorders, or drug-refractory esophageal reflux symptoms.
19. Known history of a structural or functional disorder of the stomach, including gastroparesis, gastric ulcer, chronic gastritis, gastric varices, hiatal hernia (>3 cm), cancer, or any other disorder of the stomach.
20. Known history of chronic symptoms suggestive of a structural or functional disorder of the stomach, including any symptoms of chronic upper abdominal pain, chronic nausea, chronic vomiting, chronic dyspepsia, or symptoms suggestive of gastroparesis, including post-prandial fullness or pain, post-prandial nausea or vomiting, or early satiety.
21. Currently have ongoing symptoms suggestive of intermittent small bowel obstruction, such as recurrent bouts of post-prandial abdominal pain, nausea, or vomiting.
22. Active H. pylori infection (Subjects with active H. pylori may continue with the screening process if they are treated with an appropriate antibiotic regimen, and eradication has been confirmed).
23. History of coagulopathy, upper gastrointestinal bleeding conditions such as ulcers, gastric varices, strictures, congenital or acquired intestinal telangiectasia.
24. Current use of anticoagulation therapy.
25. Obligate use of anti-inflammatory drugs that cannot be suspended for a minimum of 4 weeks post procedure.
26. Use of systemic glucocorticoids (excluding topical or ophthalmic application or inhaled forms) for more than 10 consecutive days within 90 days prior to the Screening Visit.
27. Use of drugs known to affect GI motility (e.g., Metoclopramide).
28. Receiving any weight loss medications such as Meridia, Xenical, Saxenda, Januvia, Duromine, GLP-1 agonists, GIP/GLP-1 dual agonists, or over-the-counter weight loss medications at screening.
29. Untreated/inadequately treated hypothyroidism, defined as an elevated Thyroid-Stimulating Hormone (TSH) level at Screening; if on thyroid hormone replacement therapy, must be on a stable dose for at least 6 weeks prior to Screening.
30. Persistent Anemia, defined as Hemoglobin <10 g/dL.
31. Significant cardiovascular disease including a known history of valvular disease, or myocardial infarction, heart failure, transient ischemic attack, or stroke within the last 6 months.
32. Known moderate or severe chronic kidney disease (CKD), with estimated glomerular filtration rate (eGFR) <45 ml/min/1.73m2 (estimated by MDRD).
33. Known immunocompromised status, including but not limited to individuals who have undergone organ transplantation, chemotherapy, or radiotherapy within the past 12 months, who have clinically significant leukopenia, who are positive for the human immunodeficiency virus (HIV) or whose immune status makes the subject a poor candidate for clinical trial participation in the opinion of the Investigator.
34. Active systemic infection.
35. Known active malignancy within the last 5 years (with the exception of treated basal cell or treated squamous cell carcinoma).
36. Subjects with an established diagnosis of Multiple Endocrine Neoplasia syndrome type 1.
37. Not a candidate for surgery or general anesthesia.
38. Active illicit substance abuse or alcoholism.
39. Current smoker or smoking history in the last six months.
40. Participating in another ongoing clinical trial of an investigational drug or device.
41. Any other mental or physical condition which, in the opinion of the Investigator, makes the subject a poor candidate for clinical trial participation.
42. Other medical conditions that do not allow for an endoscopic procedure.

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: Gastric Mucosal Ablation (GMA) following sleeve gastrectomy; Subjects will undergo endoscopic Gastric Mucosal Ablation (GMA) following sleeve gastrectomy. This will be performed by an experienced endoscopist specialized in bariatric endoscopy in a single endoscopic session.	Device: Gastric Mucosal Ablation (GMA); Endoscopic Gastric Mucosal Ablation (GMA) after sleeve gastrectomy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent Change in Total Body Weight Loss (TBWL) from Baseline	Measure percent change in total body weight over time following endoscopic GMA. TBWL = pre-op weight - post op body weight. % TBWL is the fraction of body weight expressed in percentage term	6 Months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of Safety Complications according to Clavien-Dindo Classification	Occurrence of complications according to the Clavien-Dindo classification	Month 1, Month 2, Month 3, Month 4, Month 6, Month 7, Month 8, Month 9, Month 10, Month 11, Month 12
Rate of Adverse Events (AE)	Occurrence of Adverse Events along with AE Type, severity, and relationship to treatment.	Month 1, Month 2, Month 3, Month 4, Month 6, Month 7, Month 8, Month 9, Month 10, Month 11, Month 12
Percent Change in Total Body Weight Loss (TBWL) from Baseline	Measure percent change in total body weight over time following endoscopic GMA. TBWL = pre-op weight - post op body weight. % TBWL is the fraction of body weight expressed in percentage term	Month 12
Glucose Homeostasis Assessment	Baseline measured fasting glucose, HOMA-IR, and HbA1c levels compared to post-intervention fasting levels at 3 Months and 6 Months using laboratory testing.	3 Months, 6 Months
Serum Levels of Lipids Assessment	Baseline compared to post-intervention fasting serum lipids levels at 3 Months and 6 Months measured by laboratory testing.	3 Months, 6 Months
Post-operative Pain Assessment	Visual Analog Scale pain score at baseline compared to postoperative follow-up visits. The VAS Pain Scores range from 0 (minimum) to 10 (maximum), where 0 represents no pain and 10 represents the maximum level of pain, with higher scores indicating greater intensity of postoperative pain.	Month 1, Month 2, Month 3, Month 4, Month 6, Month 7, Month 8, Month 9, Month 10, Month 11, Month 12
Quality of Life Assessment	Baseline quality of life assessment scores compared to 6 Month quality of life assessment scores. Quality of life score assessed and measured by the 36-Item Short Form Survey and The Impact of Weight on Quality of Life-Lite questionnaires. Scoring for both questionnaires range from 0 (minimum) to 100 (maximum). Higher scores for both questionnaires indicate higher quality of life.	6 Months
Gastric Sensory Function Assessment	Volume to comfortable fullness and Maximum Tolerated Volume measured using a visual analog scale at 3 Months and 6 Months. Volume to Comfortable Fullness and Maximum Tolerated Volume scores both range from 0 (minimum) to 100 (maximum) with a lower score indicating a smaller required volume to reach comfortable fullness and maximum fullness.	3 Months, 6 Months

Collaborators and Investigators

• Sponsor: Dr. Christopher McGowan
• Investigators: Principal Investigator: Christopher McGowan, MD, MSCR, True You Weight Loss

Publications and helpful links

General Publications

• Lauti M, Kularatna M, Hill AG, MacCormick AD. Weight Regain Following Sleeve Gastrectomy-a Systematic Review. Obes Surg. 2016 Jun;26(6):1326-34. doi: 10.1007/s11695-016-2152-x.
• Bulajic M, Vadala di Prampero SF, Boskoski I, Costamagna G. Endoscopic therapy of weight regain after bariatric surgery. World J Gastrointest Surg. 2021 Dec 27;13(12):1584-1596. doi: 10.4240/wjgs.v13.i12.1584.

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2024
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): May 1, 2026

Study Registration Dates

• First Submitted: October 31, 2024
• First Submitted That Met QC Criteria: October 31, 2024
• First Posted (Actual): November 4, 2024

Study Record Updates

• Last Update Posted (Estimated): November 5, 2024
• Last Update Submitted That Met QC Criteria: November 1, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: obesity; ablation; obesity and overweight; GMA; gastric mucosal ablation; endoscopic bariatric therapy
• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Overweight; Obesity
• Other Study ID Numbers: 20242649

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No