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LINX Reflux Management System Clinical Study Protocol

Primary Purpose

Gastroesophageal Reflux

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Magnetic Sphincter Augmentation
Sponsored by
Torax Medical Incorporated
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastroesophageal Reflux focused on measuring Gastroesophageal Reflux

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Subject must be at least 18 years of age and at least the minimum Age of Majority according to applicable State or Country Law and must be less than 75 years of age, with a life expectancy > 3 years
  • Subject is a suitable surgical candidate, i.e. is able to undergo general anesthesia and laparoscopic surgery
  • Documented typical symptoms of gastroesophageal reflux disease (GERD) for longer than 6 months (regurgitation or heartburn which is defined as a burning epigastic or substernal pain which responds to acid neutralization or suppression)
  • Patient requires daily proton pump inhibitor or other anti-reflux drug therapy
  • Total Distal Ambulatory Esophageal pH must meet the following criteria: pH< 4 for ≥ 4.5% of the time Note: Subjects shall have discontinued any GERD medications for at least 7 days prior to testing.
  • Subjects with symptomatic improvement on proton-pump inhibitor (PPI) therapy demonstrated by a GERD-Health-Related Quality of Life (GERD-HRQL) score of ≤ 10 on proton-pump inhibitors and ≥ 15 off PPIs, or subjects with a ≥ 6 point improvement when comparing their on PPI and off PPI GERD-HRQL score
  • GERD symptoms, in absence of PPI therapy (minimum 7 days)
  • If the subject is of child bearing potential must have a negative pregnancy test within one week prior to implant and must agree to use effective means of birth control during the course of the study
  • Subject is willing and able to cooperate with follow-up examinations
  • Subject has been informed of the study procedures and the treatment and has signed an informed consent form

Exclusion Criteria:

  • The procedure is an emergency procedure
  • Currently being treated with another investigational drug or investigational device
  • History of gastroesophageal surgery, anti-reflux procedures, or gastroesophageal/gastric cancer
  • Any previous endoscopic anti-reflux intervention for GERD
  • Suspected or confirmed esophageal or gastric cancer
  • Any size hiatal hernia >3cm as determined by endoscopy
  • Distal esophageal motility (average of sensors 3 and 4) is less than 35 mmHg peristaltic amplitude on wet swallows or <70% (propulsive) peristaltic sequences
  • Esophagitis - Grade C or D (LA Classification)
  • Body Mass Index (BMI)>35
  • Symptoms of dysphagia more than once per week within the last 3 months.
  • Diagnosed with Scleroderma
  • Diagnosed with an esophageal motility disorder such as but not limited to Achalasia, Nutcracker Esophagus, or Diffuse Esophageal Spasm or Hypertensive LES
  • Subject has a history of or known esophageal stricture or gross esophageal anatomic abnormalities (Schatzki's ring, obstructive lesions, etc.)
  • Subject has esophageal or gastric varices
  • Subject has history of or known Barrett's esophagus
  • Cannot understand trial requirements or is unable to comply with follow-up schedule
  • Pregnant or nursing, or plans to become pregnant during the course of the study
  • Medical illness (i.e. congestive heart failure) that may cause the subject to be non-compliant with or able to meet the protocol requirements or is associated with limited life expectancy (i.e. less than 3 years)
  • Diagnosed psychiatric disorder (e.g. bipolar, schizophrenia, etc.), subjects that exhibit depression that are on appropriate medication(s) are allowable.
  • Suspected or known allergies to titanium, stainless steel, nickel or ferrous materials
  • Subject has an electrical implant or metallic, abdominal implants

Sites / Locations

  • USC Keck School of Medicine
  • University of California - San Diego
  • Mayo Clinic
  • Phoebe Putney Memorial Hospital
  • Abbott Northwestern Hospital/MNGI
  • Washington University - Division of Gastroenterology
  • University of Rochester Medical Center
  • The Ohio State University Medical Center / Center for Minimally Invasive Surgery
  • Knox Community Hospital
  • Legacy Health System
  • University of Pittsburgh Medical Center
  • University of Washington Medical Center
  • Gundersen Lutheran Clinic
  • Academic Medical Center

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Magnetic Sphincter Augmentation

Arm Description

Single-arm study: all subjects were treated with magnetic sphincter augmentation. A subject's baseline measurements prior to sphincter augmentation were compared to post-sphincter augmentation measurements. Subjects served as their own control.

Outcomes

Primary Outcome Measures

Rate of Occurrence for Device and Procedure Related Serious Adverse Events (SAEs).
SAE was defined as any untoward medical occurrence, whether related to the study device or procedure or not, that meets one or more of the following criteria: Results in death Is life-threatening Requires subject hospitalization > 24 hours Requires prolongation of an existing hospitalization Results in persistent or significant disability/incapacity Results in fetal distress, fetal death, or a congenital anomaly or birth defect Requires intervention to prevent permanent impairment or damage. Outcome measure reports number of subjects with reported events.
Normalization of Esophageal Acid Exposure Time or Reduced Total Acid Exposure Time of at Least 50% Compared to the Subject's Baseline Measurement by Esophageal pH Testing.
The analysis cohort for the primary efficacy analysis was the treated population which includes all implanted subjects and was determined through esophageal pH testing.

Secondary Outcome Measures

At Least a 50% Reduction in Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) Total Score Compared to Baseline
Average Daily Proton-pump Inhibitor (PPI) Dosage Reduced by at Least 50% Compared to Baseline

Full Information

First Posted
October 20, 2008
Last Updated
April 3, 2018
Sponsor
Torax Medical Incorporated
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1. Study Identification

Unique Protocol Identification Number
NCT00776997
Brief Title
LINX Reflux Management System Clinical Study Protocol
Official Title
LINX Reflux Management System Clinical Study Protocol
Study Type
Interventional

2. Study Status

Record Verification Date
March 2018
Overall Recruitment Status
Completed
Study Start Date
November 2008 (undefined)
Primary Completion Date
December 2010 (Actual)
Study Completion Date
September 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Torax Medical Incorporated

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of the study is to evaluate the safety and effectiveness of the LINX Reflux Management System in the treatment of Gastroesophageal Reflux Disease (GERD).
Detailed Description
At present, the primary alternative for GERD patients with an incomplete symptomatic response to proton-pump inhibitors (PPIs) is laparoscopic Nissen fundoplication. This surgical procedure continues to be the prevalent non-medical treatment option for GERD patients, despite several important limitations. First, it is a very traumatic procedure, requiring portions of the stomach to be dissected and then wrapped around the tubular esophagus, creating permanent anatomic alterations. Secondly, it can create significant side effects, such as gas bloat syndrome, the inability to belch and the inability to vomit. The intent of the LINX System is to allow a surgeon, using existing laparoscopic techniques and instruments, to augment a weak LES and restore the defective barrier at the gastroesophageal junction (GEJ). This defect of the GEJ is the source of abnormal reflux. The LINX device is an expandable string of individual titanium beads with magnetic cores. The device is laparoscopically placed as a ring around the lower esophageal sphincter. The magnetic attraction of the beads augments the esophageal sphincter's ability to resist gastric pressures that cause reflux. At rest, the LINX device encircles the sphincter with each bead resting against an adjacent bead, to avoid compression of the tubular esophagus. When swallowing, higher pressures are created, allowing the magnetic bond between beads to break, and the LINX implant to expand radially. This serves to preserve swallow and other physiologic functions, such as belching and vomiting, and avoids the side effect of post-prandial bloating. The device can be placed with minimal dissection, preserving anatomy, and is also removable, if necessary. This provides important benefits as it preserves the native anatomy, unlike the Nissen procedure.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastroesophageal Reflux
Keywords
Gastroesophageal Reflux

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
100 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Magnetic Sphincter Augmentation
Arm Type
Other
Arm Description
Single-arm study: all subjects were treated with magnetic sphincter augmentation. A subject's baseline measurements prior to sphincter augmentation were compared to post-sphincter augmentation measurements. Subjects served as their own control.
Intervention Type
Device
Intervention Name(s)
Magnetic Sphincter Augmentation
Other Intervention Name(s)
LINX Reflux Management System, Magnetic Esophageal Sphincter
Intervention Description
The area of the lower esophageal sphincter (LES) is accessed using a standard laparoscopic approach. The tubular esophagus, in the area of the LES, is sized and the appropriately sized sphincter augmentation device is placed circumferentially around the esophagus in the area of the LES. After confirming proper placement, the ends of the device are secured. At this point, the implant procedure is complete, laparoscopic instruments are withdrawn and access points are closed.
Primary Outcome Measure Information:
Title
Rate of Occurrence for Device and Procedure Related Serious Adverse Events (SAEs).
Description
SAE was defined as any untoward medical occurrence, whether related to the study device or procedure or not, that meets one or more of the following criteria: Results in death Is life-threatening Requires subject hospitalization > 24 hours Requires prolongation of an existing hospitalization Results in persistent or significant disability/incapacity Results in fetal distress, fetal death, or a congenital anomaly or birth defect Requires intervention to prevent permanent impairment or damage. Outcome measure reports number of subjects with reported events.
Time Frame
through 24 months
Title
Normalization of Esophageal Acid Exposure Time or Reduced Total Acid Exposure Time of at Least 50% Compared to the Subject's Baseline Measurement by Esophageal pH Testing.
Description
The analysis cohort for the primary efficacy analysis was the treated population which includes all implanted subjects and was determined through esophageal pH testing.
Time Frame
12 Months
Secondary Outcome Measure Information:
Title
At Least a 50% Reduction in Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) Total Score Compared to Baseline
Time Frame
12 months
Title
Average Daily Proton-pump Inhibitor (PPI) Dosage Reduced by at Least 50% Compared to Baseline
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject must be at least 18 years of age and at least the minimum Age of Majority according to applicable State or Country Law and must be less than 75 years of age, with a life expectancy > 3 years Subject is a suitable surgical candidate, i.e. is able to undergo general anesthesia and laparoscopic surgery Documented typical symptoms of gastroesophageal reflux disease (GERD) for longer than 6 months (regurgitation or heartburn which is defined as a burning epigastic or substernal pain which responds to acid neutralization or suppression) Patient requires daily proton pump inhibitor or other anti-reflux drug therapy Total Distal Ambulatory Esophageal pH must meet the following criteria: pH< 4 for ≥ 4.5% of the time Note: Subjects shall have discontinued any GERD medications for at least 7 days prior to testing. Subjects with symptomatic improvement on proton-pump inhibitor (PPI) therapy demonstrated by a GERD-Health-Related Quality of Life (GERD-HRQL) score of ≤ 10 on proton-pump inhibitors and ≥ 15 off PPIs, or subjects with a ≥ 6 point improvement when comparing their on PPI and off PPI GERD-HRQL score GERD symptoms, in absence of PPI therapy (minimum 7 days) If the subject is of child bearing potential must have a negative pregnancy test within one week prior to implant and must agree to use effective means of birth control during the course of the study Subject is willing and able to cooperate with follow-up examinations Subject has been informed of the study procedures and the treatment and has signed an informed consent form Exclusion Criteria: The procedure is an emergency procedure Currently being treated with another investigational drug or investigational device History of gastroesophageal surgery, anti-reflux procedures, or gastroesophageal/gastric cancer Any previous endoscopic anti-reflux intervention for GERD Suspected or confirmed esophageal or gastric cancer Any size hiatal hernia >3cm as determined by endoscopy Distal esophageal motility (average of sensors 3 and 4) is less than 35 mmHg peristaltic amplitude on wet swallows or <70% (propulsive) peristaltic sequences Esophagitis - Grade C or D (LA Classification) Body Mass Index (BMI)>35 Symptoms of dysphagia more than once per week within the last 3 months. Diagnosed with Scleroderma Diagnosed with an esophageal motility disorder such as but not limited to Achalasia, Nutcracker Esophagus, or Diffuse Esophageal Spasm or Hypertensive LES Subject has a history of or known esophageal stricture or gross esophageal anatomic abnormalities (Schatzki's ring, obstructive lesions, etc.) Subject has esophageal or gastric varices Subject has history of or known Barrett's esophagus Cannot understand trial requirements or is unable to comply with follow-up schedule Pregnant or nursing, or plans to become pregnant during the course of the study Medical illness (i.e. congestive heart failure) that may cause the subject to be non-compliant with or able to meet the protocol requirements or is associated with limited life expectancy (i.e. less than 3 years) Diagnosed psychiatric disorder (e.g. bipolar, schizophrenia, etc.), subjects that exhibit depression that are on appropriate medication(s) are allowable. Suspected or known allergies to titanium, stainless steel, nickel or ferrous materials Subject has an electrical implant or metallic, abdominal implants
Facility Information:
Facility Name
USC Keck School of Medicine
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
University of California - San Diego
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States
Facility Name
Mayo Clinic
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
Facility Name
Phoebe Putney Memorial Hospital
City
Albany
State/Province
Georgia
ZIP/Postal Code
31701
Country
United States
Facility Name
Abbott Northwestern Hospital/MNGI
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55407
Country
United States
Facility Name
Washington University - Division of Gastroenterology
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
University of Rochester Medical Center
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States
Facility Name
The Ohio State University Medical Center / Center for Minimally Invasive Surgery
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
Knox Community Hospital
City
Mount Vernon
State/Province
Ohio
ZIP/Postal Code
43050
Country
United States
Facility Name
Legacy Health System
City
Portland
State/Province
Oregon
ZIP/Postal Code
97210
Country
United States
Facility Name
University of Pittsburgh Medical Center
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
Facility Name
University of Washington Medical Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98195
Country
United States
Facility Name
Gundersen Lutheran Clinic
City
La Crosse
State/Province
Wisconsin
ZIP/Postal Code
54601
Country
United States
Facility Name
Academic Medical Center
City
Amsterdam
ZIP/Postal Code
1105 AZ
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
26044316
Citation
Ganz RA, Edmundowicz SA, Taiganides PA, Lipham JC, Smith CD, DeVault KR, Horgan S, Jacobsen G, Luketich JD, Smith CC, Schlack-Haerer SC, Kothari SN, Dunst CM, Watson TJ, Peters J, Oelschlager BK, Perry KA, Melvin S, Bemelman WA, Smout AJ, Dunn D. Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux. Clin Gastroenterol Hepatol. 2016 May;14(5):671-7. doi: 10.1016/j.cgh.2015.05.028. Epub 2015 Jun 2.
Results Reference
derived
PubMed Identifier
23425164
Citation
Ganz RA, Peters JH, Horgan S, Bemelman WA, Dunst CM, Edmundowicz SA, Lipham JC, Luketich JD, Melvin WS, Oelschlager BK, Schlack-Haerer SC, Smith CD, Smith CC, Dunn D, Taiganides PA. Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med. 2013 Feb 21;368(8):719-27. doi: 10.1056/NEJMoa1205544.
Results Reference
derived

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LINX Reflux Management System Clinical Study Protocol

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