Endoscopic Suturing of the Gastric Pylorus to Delay Gastric Emptying and Treat Obesity
Primary Purpose
Obesity, Over Weight
Status
Terminated
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Pyloric restriction
Sponsored by

About this trial
This is an interventional treatment trial for Obesity focused on measuring Obesity Treatment, Endoscopy, Pyloric Suturing, Pyloric restriction
Eligibility Criteria
Inclusion Criteria:
- Age 18- 65
- Male or female participants with a BMI >30 and < 45
- Female participants of childbearing age should not be pregnant, must have a negative serum or urine test and agree to use birth control for duration of the study.
- Participant did not undergo previous Roux-en-Y bypass with the gastric pouch limited to the cardia
Exclusion Criteria:
- Allergic to eggs or egg products, wheat, Gluten or Prolamins.
- currently on life saving oral medications
- Participants allergic to Scopolamine
- Participants allergic to botulinum toxin
- Participants who are currently on oral medications for their serious medical conditions.
- Recent tobacco cessation (within 3 months prior to planned enrollment) or plan to quit smoking during the study
- Infection anywhere in the body at time of procedure or other diseases that would make participant unsuitable for treatment (e.g., systemic disease, HIV, malignancy, autoimmune disease, etc.)
- patients who cannot undergo endoscopy
- Active disease of the gastrointestinal tract including esophageal inflammation, varices or ulceration, or specific inflammation such as Crohn's disease or ulcerative colitis
- Esophageal or cricopharyngeal narrowing or stricture; distorted esophagus or known esophageal pouch
- Heavily scarred, malignant, or poor quality (e.g., friable or overly compliant) tissue in area to be sutured
- Severe eating disorders such as bulimia (use of purgatives/laxatives) or anorexia nervosa
- Significant movement limitations of lower extremities (e.g., cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device or is severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition)
- Recently (within previous 3 months) prescribed or initiated therapy with medication(s) known to cause significant weight gain or likely to require treatment with such medication(s) during the study OR is currently taking or has taken within the previous 3 months prescription or over-the-counter weight loss medications (e.g., medications and/or supplements containing ephedrine, phenylpropanolamine, amphetamines, etc.). Additionally, use of such medications and weight loss/appetite suppressing dietary supplements are prohibited during the course of the trial including the screening period
- Participant has history of significant cardiovascular or pulmonary disease (e.g., myocardial infarct, unstable angina, congestive heart failure, pulmonary edema or COPD) or other significant cerebrovascular disease (e.g., stroke)
- Not a candidate for general or conscious/moderate sedation
- Participant is on anticoagulant therapy (heparin, coumadin, Plavix, Ticlid, etc.) and must discontinue use of 325 mg aspirin within 6 weeks of procedure
- Active substance abuse (e.g., alcohol or drugs). This is done with personal interview only. No drug tests are being performed to determine the active abuse
- The participant has life expectancy of less than 1 year due to other medical conditions
- The participant is currently enrolled in another investigational drug or device trial that has not completed the primary endpoint or that clinically interferes with this trials study endpoints
- Patients having Diabetes
Sites / Locations
- North Shore University Hospital
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Pyloric restriction
Arm Description
Endoscopic method of pyloric restriction in order to decrease gastric emptying. The hypothesis is that this will cause and early and prolonged satiety which will inturn lead to decreased food consumption and lead to weight loss.
Outcomes
Primary Outcome Measures
Percent weight loss
The primary endpoint of this study is percent weight loss at 1, 3 and 6 months (using the weight taken at the baseline visit as the baseline weight). Percent weight lost will be calculated as follows: [(Baseline Weight - Final 6 month Weight)/Baseline Weight] x 100%.
Secondary Outcome Measures
Participant satisfaction
Participant satisfaction with clinical outcomes at 6 months post-procedure will be captured on an ordinal scale of 1 to 5 with 1 representing very satisfied and 5 representing not satisfied at all. The response will be tabulated and presented using descriptive statistics.
Delay in gastric emptying
A gastric emptying scan will be done prior to the endoscopic suturing procedure and four weeks after the endoscopic procedure to determine the rate of emptying of the stomach, the regional emptying of the upper and lower stomach, and the frequency and amplitude of contractions in the lower stomach.
Change in BMI
BMI at 1, 3 and 6 months will be tabulated and summarized using descriptive statistics.
Percentage of Responders
Percentage of participants losing at least 5%, 10%, 15% and 20% of weight at 1, 3 and 6 months will be tabulated and reported.
Change in Medication Use.
If the participant is taking any medications for Obesity related complications such as Hypertension and Diabetes, then the dosage of those medications at 1, 3 and 6 months will be recorded and trends will be noted as either remained the same, decreased or increased.
Full Information
NCT ID
NCT02191501
First Posted
July 11, 2014
Last Updated
February 20, 2019
Sponsor
Northwell Health
Collaborators
American Society for Gastrointestinal Endoscopy
1. Study Identification
Unique Protocol Identification Number
NCT02191501
Brief Title
Endoscopic Suturing of the Gastric Pylorus to Delay Gastric Emptying and Treat Obesity
Official Title
Endoscopic Suturing of the Gastric Pylorus to Delay Gastric Emptying and Treat Obesity
Study Type
Interventional
2. Study Status
Record Verification Date
February 2019
Overall Recruitment Status
Terminated
Why Stopped
Suspended as we are looking for more durable method/device
Study Start Date
May 7, 2013 (Actual)
Primary Completion Date
August 1, 2017 (Actual)
Study Completion Date
November 9, 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Northwell Health
Collaborators
American Society for Gastrointestinal Endoscopy
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to demonstrate the efficacy and safety of endoscopic suturing of the gastric pylorus to delay gastric emptying and treat obesity.
Detailed Description
The purpose of this study is to evaluate the safety, technical feasibility, and effectiveness of a endoscopic guided treatment for obesity - endoscopic pyloric suturing. The hypothesis and rationale for the study is that gastric pyloric restriction will cause early and prolonged satiety which will lead to decreased food intake and eventual weight loss. Both safety and efficacy of endoscopic pyloric suturing has been demonstrated in an animal model.
Screening of the participant is done 6-8 weeks prior to the procedure. Screening includes general history and physical examination, biochemical and laboratory analysis and informed consent. A baseline patient visit is performed 4-6 weeks prior to the procedure. The baseline visit involves a four hour gastric emptying scan in order to determine the rate of emptying of the stomach, the regional emptying of the upper and lower stomach, and the frequency and amplitude of contractions in the lower stomach. The baseline visit also includes nutritional counselling.
The procedure is performed in the endoscopy suite as an outpatient procedure. Patient will be prepped following usual practices and placed in a left lateral decubitus position. Following induction of sedation or anesthesia by the anesthesia provider, a complete endoscopic evaluation of the esophagus, stomach and jejunum following standard medical practices will be performed. The endoscope with mounted suturing device is advanced through an over-tube to the antrum and assess target area for stitch placement (physician will select appropriate target site in relation to participant's anatomy). The number of sutures required will vary for each procedure based on the size of the pylorus; however, it is thought that one or two sutures across the pylorus will be sufficient enough to achieve a functional restriction of the pylorus.
Participants will to be observed for a minimum of 1 hour following the procedure to monitor for adverse events. Patients will be recommended to take the following medications in order to minimize complications following pyloric suturing procedure; Proton Pump Inhibitor Omeprazole 40 mg recommended daily for 1 week prior to planned procedure date - and 40 mg twice daily after the procedure, Anti-Emetic -- Reglan or Zofran at the end of procedure and as needed after the procedure, and Scopalamine Patch to prevent nausea and vomiting.
All participants will be required to adhere to the follow-up schedule outlined below unless they have withdrawn their consent or died. The reason(s) the participant is not followed will be documented by the investigator. Follow-up for all participants will include a telephone contact at 1 and 18 weeks and clinic visits at 2,4, 8,10,12 and 24 weeks. At the 4 week visit, the participants will undergo a repeat four hour gastric emptying scan. At 3 months after the procedure participants will undergo repeat endoscopy to access the stomach and the suture site.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity, Over Weight
Keywords
Obesity Treatment, Endoscopy, Pyloric Suturing, Pyloric restriction
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
8 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Pyloric restriction
Arm Type
Experimental
Arm Description
Endoscopic method of pyloric restriction in order to decrease gastric emptying. The hypothesis is that this will cause and early and prolonged satiety which will inturn lead to decreased food consumption and lead to weight loss.
Intervention Type
Procedure
Intervention Name(s)
Pyloric restriction
Intervention Description
The Apollo Overstitch Suturing Device is FDA approved for suturing in the gastrointestinal tract.
However, the suturing device has never been used for suturing the pylorus in humans before. This procedure is not standard medical care. The safety and effectiveness of this procedure are being tested.
Primary Outcome Measure Information:
Title
Percent weight loss
Description
The primary endpoint of this study is percent weight loss at 1, 3 and 6 months (using the weight taken at the baseline visit as the baseline weight). Percent weight lost will be calculated as follows: [(Baseline Weight - Final 6 month Weight)/Baseline Weight] x 100%.
Time Frame
At 1, 3 and 6 months
Secondary Outcome Measure Information:
Title
Participant satisfaction
Description
Participant satisfaction with clinical outcomes at 6 months post-procedure will be captured on an ordinal scale of 1 to 5 with 1 representing very satisfied and 5 representing not satisfied at all. The response will be tabulated and presented using descriptive statistics.
Time Frame
At 6 months post procedure
Title
Delay in gastric emptying
Description
A gastric emptying scan will be done prior to the endoscopic suturing procedure and four weeks after the endoscopic procedure to determine the rate of emptying of the stomach, the regional emptying of the upper and lower stomach, and the frequency and amplitude of contractions in the lower stomach.
Time Frame
From baseline to 4 weeks post procedure
Title
Change in BMI
Description
BMI at 1, 3 and 6 months will be tabulated and summarized using descriptive statistics.
Time Frame
At 1, 3 and 6 Months
Title
Percentage of Responders
Description
Percentage of participants losing at least 5%, 10%, 15% and 20% of weight at 1, 3 and 6 months will be tabulated and reported.
Time Frame
At 1, 3 and 6 Months
Title
Change in Medication Use.
Description
If the participant is taking any medications for Obesity related complications such as Hypertension and Diabetes, then the dosage of those medications at 1, 3 and 6 months will be recorded and trends will be noted as either remained the same, decreased or increased.
Time Frame
At 1, 3 and 6 Months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age 18- 65
Male or female participants with a BMI >30 and < 45
Female participants of childbearing age should not be pregnant, must have a negative serum or urine test and agree to use birth control for duration of the study.
Participant did not undergo previous Roux-en-Y bypass with the gastric pouch limited to the cardia
Exclusion Criteria:
Allergic to eggs or egg products, wheat, Gluten or Prolamins.
currently on life saving oral medications
Participants allergic to Scopolamine
Participants allergic to botulinum toxin
Participants who are currently on oral medications for their serious medical conditions.
Recent tobacco cessation (within 3 months prior to planned enrollment) or plan to quit smoking during the study
Infection anywhere in the body at time of procedure or other diseases that would make participant unsuitable for treatment (e.g., systemic disease, HIV, malignancy, autoimmune disease, etc.)
patients who cannot undergo endoscopy
Active disease of the gastrointestinal tract including esophageal inflammation, varices or ulceration, or specific inflammation such as Crohn's disease or ulcerative colitis
Esophageal or cricopharyngeal narrowing or stricture; distorted esophagus or known esophageal pouch
Heavily scarred, malignant, or poor quality (e.g., friable or overly compliant) tissue in area to be sutured
Severe eating disorders such as bulimia (use of purgatives/laxatives) or anorexia nervosa
Significant movement limitations of lower extremities (e.g., cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device or is severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition)
Recently (within previous 3 months) prescribed or initiated therapy with medication(s) known to cause significant weight gain or likely to require treatment with such medication(s) during the study OR is currently taking or has taken within the previous 3 months prescription or over-the-counter weight loss medications (e.g., medications and/or supplements containing ephedrine, phenylpropanolamine, amphetamines, etc.). Additionally, use of such medications and weight loss/appetite suppressing dietary supplements are prohibited during the course of the trial including the screening period
Participant has history of significant cardiovascular or pulmonary disease (e.g., myocardial infarct, unstable angina, congestive heart failure, pulmonary edema or COPD) or other significant cerebrovascular disease (e.g., stroke)
Not a candidate for general or conscious/moderate sedation
Participant is on anticoagulant therapy (heparin, coumadin, Plavix, Ticlid, etc.) and must discontinue use of 325 mg aspirin within 6 weeks of procedure
Active substance abuse (e.g., alcohol or drugs). This is done with personal interview only. No drug tests are being performed to determine the active abuse
The participant has life expectancy of less than 1 year due to other medical conditions
The participant is currently enrolled in another investigational drug or device trial that has not completed the primary endpoint or that clinically interferes with this trials study endpoints
Patients having Diabetes
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Larry S Miller, MD
Organizational Affiliation
The Feinstein Institute for Medical Research
Official's Role
Principal Investigator
Facility Information:
Facility Name
North Shore University Hospital
City
Manhasset
State/Province
New York
ZIP/Postal Code
11030
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Links:
URL
http://www.feinsteininstitute.org/clinical-research/clinical-research-studies/clinical-trial/13-037B/
Description
Description and location of study
Learn more about this trial
Endoscopic Suturing of the Gastric Pylorus to Delay Gastric Emptying and Treat Obesity
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