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Et tarmbehandlingsprogram (retrograd rektalt lavement) til behandling af lavt anterior resektionssyndrom hos patienter med endetarmskræft

2. oktober 2026 opdateret af: Alessandra, Ohio State University Comprehensive Cancer Center

Lavt anterior resektionssyndrom: Retrograd lavementprogram vs medicinsk ledelse

This clinical trial studies if a bowel management program with a retrograde rectal enema (RRE) for the treatment of low anterior resection syndrome (LARS) in rectal cancer patients is better than medical management alone. Rectal cancer treatment can include a procedure where part of the rectum with cancer is removed and the remaining part of the rectum is reconnected to the colon, this is called a low anterior resection of the rectum. LARS is a common condition that can develop after undergoing a low anterior resection of the rectum. LARS consists of any change in how the body performs defecation, the discharge of feces from the body, after undergoing a resection procedure. Patients with LARS may experience fecal urgency, incontinence, increased frequency, constipation, feelings of incomplete bowel movement, or bowel emptying difficulties. Patients may experience individual symptoms of LARS or a combination of them. A bowel management program assists patient's with identifying a specific bowel management regimen that works best for managing symptoms of LARS. A RRE consists of inserting a catheter through the anus into the rectum. The RRE is designed to assist fecal emptying. Medical management of LARS can include the use of fiber, loperamide hydrochloride, or pelvic floor physical therapy. Fiber may help relieve constipation, feelings of incomplete bowel movement, or bowel emptying difficulties. Loperamide hydrocholoride may help lessen fecal urgency, incontinence, or increased frequency. Pelvic floor physical therapy may help restore strength in the rectum possibly helping to improve symptoms of LARS. Participating in a bowel management program with a RRE may be more effective in treating LARS than medical management alone.

Studieoversigt

Status

Rekruttering

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

PRIMARY OBJECTIVE:

I. To compare two approved pathways for treatment of low anterior resection syndrome (LARS) - a retrograde enema program versus a medical management pathway.

SECONDARY OBJECTIVE:

I. The determination of feasibility to complete this treatment pathway.

OUTLINE: Patients are randomized to 1 of 2 groups.

GROUP I: Patients undergo a bowel management program comprising a medical management pathway (fiber, loperamide hydrochloride, pelvic floor physical therapy) in combination with RRE treatment for 1 year. Patients use the RRE system to self administer an individualized enema regimen via the rectum. Patients may undergo abdominal film x-rays throughout the trial.

GROUP II: Patients receive medical management comprising fiber, loperamide hydrochloride, and pelvic floor therapy for 1 year. If medical management fails, patients may then be referred for surgery with sacral nerve stimulator placement.

Upon completion of study intervention all patients are followed up at 1 month, 3 months, and 1 year.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

80

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

  • Forenede Stater
    • Ohio
      • Columbus, Ohio, Forenede Stater, 43210
        • Rekruttering
        • Ohio State University Comprehensive Cancer Center
        • Kontakt:
        • Ledende efterforsker:
          • Alessandra C. Gasior, DO

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Age ≥ 18 years old
  • Moderate to Severe LARS diagnosis
  • Patients with history of rectal cancer that was treated with proctectomy
  • Has undergone standard medical management without improvement of symptoms for 3-6 months

Exclusion Criteria:

  • Patients presenting with significant stricture that need a definitive surgical management strategy; patients with minor or clinically negligible strictures can still be candidates. Patients who are able to pass the catheter and the balloon per rectum may be candidates after a digital rectal exam at their initial visit
  • Patients with any chemo or radiation therapy in the last 6 months
  • Patients who currently have colorectal cancer
  • Patients with recurrent colorectal cancer
  • Patients who have undergone a colorectal surgical procedure within the last three months
  • Patients with progressive neurological disease
  • Patients with active or recurrent sacral infection
  • Patients < 18 years old
  • Active sacral nerve simulator
  • Pregnant or planning to become pregnant during the treatment portion of the study
  • Altered mental status or mental disability that would alter ability to self-administer enema
  • Any reason the research team believes the subject is not an appropriate candidate for this study (i.e., transportation issues, history of no-show appointments, lack of reliable communications, vulnerable population(s), etc.)

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Støttende pleje
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Group I (RRE, medical management)

Patients undergo a bowel management program comprising a medical management pathway (fiber, loperamide hydrochloride, pelvic floor physical therapy) in combination with RRE treatment for 1 year. Patients use the RRE system to self administer an individualized enema regimen via the rectum. Patients may undergo abdominal film x-rays throughout the trial.
Andet: Questionnaire Administration

Ancillary studies

Kosttilskud: Dietary Fiber

Receive dietary fiber

Andre navne:
  • Fiber
Procedure: Enema Administration

Undergo RRE

Andre navne:
  • Klyster
  • Enema Injection
Medicin: Loperamide Hydrochloride

Receive loperamide hydrochloride

Andre navne:
  • Imodium
  • Imodium A-D
Procedure: Physical Therapy

Undergo pelvic floor physical therapy

Andre navne:
  • Fysiatrisk procedure
  • Fysisk medicinsk procedure
  • Fysioterapi
  • Fysioterapi procedure
Procedure: X-Ray Imaging

Undergo abdominal film x-ray

Andre navne:
  • Konventionel røntgen
  • Diagnostisk radiologi
  • Medicinsk billeddannelse, røntgen
  • Radiografisk billeddannelse
  • Radiografi
  • Statisk røntgen
  • Røntgen
  • Almindelige film røntgenbilleder
  • Radiografisk billeddannelsesprocedure (procedure)
Aktiv komparator: Group II (medical management)

Patients receive medical management comprising fiber, loperamide hydrochloride, and pelvic floor therapy for 1 year. If medical management fails, patients may then be referred for surgery with sacral nerve stimulator placement.
Andet: Questionnaire Administration

Ancillary studies

Kosttilskud: Dietary Fiber

Receive dietary fiber

Andre navne:
  • Fiber
Medicin: Loperamide Hydrochloride

Receive loperamide hydrochloride

Andre navne:
  • Imodium
  • Imodium A-D
Procedure: Physical Therapy

Undergo pelvic floor physical therapy

Andre navne:
  • Fysiatrisk procedure
  • Fysisk medicinsk procedure
  • Fysioterapi
  • Fysioterapi procedure

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Fecal incontinence
Tidsramme: Up to 1 year from start of treatment

Will be measured using a validated scoring tool for LARS (Memorial Sloan Kettering Cancer Center Bowel Function Instrument Questionnaire [MSKCC BFI]). Effect size (Cohen's d > 0.80) will be computed to ensure the effect of findings. P < 0.05 is considered significant. Statistical analysis will be conducted using linear or nonlinear mixed modelling as found appropriate by the statistician.
Up to 1 year from start of treatment
Effectiveness assessed using LARS validated scoring tool
Tidsramme: Up to 1 year from start of treatment

Will be assessed using LARS validated scoring tool. Effect size (Cohen's d > 0.80) will be computed to ensure the effect of findings. P < 0.05 is considered significant. Statistical analysis will be conducted using linear or nonlinear mixed modelling as found appropriate by the statistician.
Up to 1 year from start of treatment

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Feasibility measured by Patient Satisfaction Survey
Tidsramme: At 1 year from start of treatment

Will be assessed by administering a patient satisfaction survey post treatment. Effect size (Cohen's d > 0.80) will be computed to ensure the effect of findings. P < 0.05 is considered significant. Statistical analysis will be conducted using linear or nonlinear mixed modelling as found appropriate by the statistician.
At 1 year from start of treatment

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Ohio State University Comprehensive Cancer Center

Efterforskere

  • Ledende efterforsker: Alessandra C Gasior, DO, Ohio State University Comprehensive Cancer Center

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Hjælpsomme links

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

15. februar 2027

Primær færdiggørelse (Anslået)

31. december 2028

Studieafslutning (Anslået)

31. december 2028

Datoer for studieregistrering

Først indsendt

16. maj 2024

Først indsendt, der opfyldte QC-kriterier

16. maj 2024

Først opslået (Faktiske)

22. maj 2024

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

6. oktober 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

2. oktober 2026

Sidst verificeret

1. september 2026

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • OSU-22312
  • NCI-2024-03173 (Registry Identifier: CTRP (Clinical Trial Reporting Program))

Plan for individuelle deltagerdata (IPD)

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