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Clinical and Urgent Colonoscopy Outcomes Using the Pure-Vu® Cleansing System

Primary Purpose

Lower Gastrointestinal Bleeding, Hemostatic Disorder

Status
Terminated
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Pure-Vu Cleansing Device
Sponsored by
The Cleveland Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional device feasibility trial for Lower Gastrointestinal Bleeding focused on measuring Colonoscopy, Bowel Preparation

Eligibility Criteria

22 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Hospitalized patients in the ICU or the RNF with acute LGIB (defined as maroon-colored stool or bright red blood per rectum with suspicion of acute blood loss anemia, and hemodynamically stable and/or stabilized at the time of procedure . Hospitalized patients include:

    • Patients who develop LGIB while admitted for different reasons
    • Patients transferred from an outside hospital for further management of acute LGIB
    • Patients admitted through the emergency room for management of acute LGIB
  • At least 22 years old
  • Undergoing urgent colonoscopy under monitored anesthesia care or conscious sedation

Exclusion Criteria:

  • Suspicion for bowel obstruction/ stricture
  • Toxic megacolon or severe colitis (determined by degree of colitis on imaging and clinical condition including pain, fevers, abdominal exam, elevated inflammatory markers)
  • Active Diverticulitis

Sites / Locations

  • Cleveland Clinic

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Pure-Vu Treatment

Arm Description

Participants in this arm will undergo colonoscopy using the Pure-Vu cleansing device.

Outcomes

Primary Outcome Measures

Adequate Bowel Preparation
The proportion of participants who achieve an adequate bowel preparation to identify bleeding lesions

Secondary Outcome Measures

Diagnostic yield
The frequency with which investigators are able to successfully identify the source of bleeding.
Therapeutic Yield
The frequency with which investigators are able to successfully control bleeding through endoscopic intervention
Re-bleeding rate
The proportion of participants who experience recurrence of bleeding

Full Information

First Posted
January 25, 2021
Last Updated
June 21, 2023
Sponsor
The Cleveland Clinic
Collaborators
Motus GI Medical Technologies Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT04729946
Brief Title
Clinical and Urgent Colonoscopy Outcomes Using the Pure-Vu® Cleansing System
Official Title
Clinical and Urgent Colonoscopy Outcomes Using the Pure-Vu® Cleansing System in Hospitalized Patients With Lower Gastrointestinal Bleeding: A Single-Center Prospective Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Terminated
Why Stopped
Difficulty recruiting
Study Start Date
March 3, 2021 (Actual)
Primary Completion Date
April 6, 2022 (Actual)
Study Completion Date
April 6, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The Cleveland Clinic
Collaborators
Motus GI Medical Technologies Ltd

4. Oversight

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
Data Monitoring Committee
No

5. Study Description

Brief Summary
The Pure-Vu® System can be effectively used as a cleansing device in patients admitted with acute LGIB to the intensive care unit and the regular nurse floor (RNF) bypassing the need to administer an oral bowel preparation for adequate visualization and hence decreasing time to colonoscopy and improving diagnostic and therapeutic yield.
Detailed Description
Acute lower gastrointestinal bleeding (LGIB), while generally defined as gastrointestinal bleeding distal to the ligament of Treitz, can be categorized into small bowel and colorectal bleeding, two sites with distinct presentations as well as diagnostic and management options (1). Acute LGIB secondary to a colorectal source usually presents with sudden onset hematochezia with or without acute blood loss anemia and hemodynamic instability, and usually leads to multiple invasive procedures and hospitalizations. It accounts for up to one-third of all hospitalizations related to GIB (2). The current guidelines recommend urgent colonoscopy to be performed within 8 to 24 hours of presentation and after adequate colon preparation to improve visualization and diagnostic/therapeutic yield (1). While studies looking at optimal timing of colonoscopy are limited for patients with acute LGIB, a study comparing 48 patients with diverticular bleeding who underwent colonoscopy after rapid polyethylene glycol (PEG) preparation and within 12 hours of presentation with endoscopic hemostasis compared to 73 controls without endoscopic hemostasis, found a significant improvement in outcomes in the group that underwent hemostasis, including bleeding (0% vs. 53%) and hospital length (median of 2 days vs. 5 days) (3). In another RCT of 100 patients presenting with LGIB, colonoscopy within 8 hours of presentation after rapid preparation lead to a more definite diagnosis compared to patients who underwent elective colonoscopy within 96 hours of presentation (4). Urgent colonoscopy however requires the rapid administration of a large volume bowel preparation over 3-4 hours until the rectal effluent is clear (1). Purge preparation can be challenging in critically ill patients and frequently requires the placement of a nasogastric tube for administration of the preparation which could place the patient at risk of aspiration, poor tolerance, and rarely, electrolyte imbalances (1). Moreover, bleeding can subside while awaiting resuscitation and bowel preparation prior to endoscopic intervention, which could lead to a decreased diagnostic and therapeutic yield. The guidelines recommend against unprepped colonoscopy due to poor visualization and increased perforation risk (1). A pilot study looked at the effect of "hydroflush colonoscopy" in acute LGIB with minimally prepped colons (tap water enema without oral preparation). "Hydroflush colonoscopy" was defined as colonoscopy using a combination of a water jet pump irrigation and a mechanical endoscope suction device (BioVac direct suction device). Out of the 12 patients included, the cecum was reached 69% of the time and endoscopic visualization was found to be adequate to find the source of bleeding in all procedures (5). The Pure-Vu® System (MotusGI Ltd.), a novel Food and Drug Administration (FDA) 510k cleared intra-procedural cleansing device, has been recently introduced. The Pure-Vu® System integrates with the colonoscope and generates a pulsed vortex mixture of water and air in order to remove debris and is active at the time of cleansing to evacuate colonic contents simultaneously (6). Its effectiveness has been studied in colonoscopies requiring minimal preparation regimens with excellent and safe results (7,8). A multicenter European feasibility study looked at 47 patients referred for colonoscopy who received a limited bowel preparation and found significant improvement in the proportion of patients with adequate preparation, with a median Boston bowel preparation score (BBPS) increased from 3[0-5] to 9 [8-9] (8). The REDUCE trial (9), another multicenter, single-arm study, was the first trial to study Pure-Vu® in the inpatient setting, which enrolled 95 hospitalized subjects. Adequate bowel preparation improved from 38% (95% CI 28,49) to 96% (CI 90-99) in the evaluated segments. The mean BBPS improved from 1.74 in the left colon, 1.74 in the transverse colon, 1.5 in the right colon to 2.89, 2.91 and 2.86 respectively (p<0.001) (9).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lower Gastrointestinal Bleeding, Hemostatic Disorder
Keywords
Colonoscopy, Bowel Preparation

7. Study Design

Primary Purpose
Device Feasibility
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Single-Center Pilot Study
Masking
None (Open Label)
Masking Description
No Masking is planned
Allocation
N/A
Enrollment
6 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Pure-Vu Treatment
Arm Type
Experimental
Arm Description
Participants in this arm will undergo colonoscopy using the Pure-Vu cleansing device.
Intervention Type
Device
Intervention Name(s)
Pure-Vu Cleansing Device
Intervention Description
The Pure-Vu device attaches to the colonoscope and provides colonic cleansing during urgent colonoscopy without the need for a bowel preparation
Primary Outcome Measure Information:
Title
Adequate Bowel Preparation
Description
The proportion of participants who achieve an adequate bowel preparation to identify bleeding lesions
Time Frame
During the colonoscopy procedure, typically less than 1 hour
Secondary Outcome Measure Information:
Title
Diagnostic yield
Description
The frequency with which investigators are able to successfully identify the source of bleeding.
Time Frame
During the colonoscopy procedure, typically less than 1 hour
Title
Therapeutic Yield
Description
The frequency with which investigators are able to successfully control bleeding through endoscopic intervention
Time Frame
During the colonoscopy procedure, typically less than 1 hour
Title
Re-bleeding rate
Description
The proportion of participants who experience recurrence of bleeding
Time Frame
48 hours post-colonoscopy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
22 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Hospitalized patients in the ICU or the RNF with acute LGIB (defined as maroon-colored stool or bright red blood per rectum with suspicion of acute blood loss anemia, and hemodynamically stable and/or stabilized at the time of procedure . Hospitalized patients include: Patients who develop LGIB while admitted for different reasons Patients transferred from an outside hospital for further management of acute LGIB Patients admitted through the emergency room for management of acute LGIB At least 22 years old Undergoing urgent colonoscopy under monitored anesthesia care or conscious sedation Exclusion Criteria: Suspicion for bowel obstruction/ stricture Toxic megacolon or severe colitis (determined by degree of colitis on imaging and clinical condition including pain, fevers, abdominal exam, elevated inflammatory markers) Active Diverticulitis
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brian Baggott, MD
Organizational Affiliation
The Cleveland Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Clinical and Urgent Colonoscopy Outcomes Using the Pure-Vu® Cleansing System

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