Location of Lesions Responsible for Blood Loss in the Gastrointestinal (GI) Tract (A-MACE)
Primary Purpose
Iron Deficiency Anemia
Status
Unknown status
Phase
Not Applicable
Locations
Hong Kong
Study Type
Interventional
Intervention
MACE
Sponsored by
About this trial
This is an interventional diagnostic trial for Iron Deficiency Anemia focused on measuring magnetically assisted capsule endoscopy
Eligibility Criteria
Inclusion Criteria:
- Male and female patients aged 18 years and over and up to but not exceeding 80 years
- Patients presenting with IDA whom require gastroscopy and colonoscopy as per national guidelines (1)
Exclusion Criteria:
- Patients who have contraindications to gastroscopy or colonoscopy
- Patients under the age of 18 years
- Patients over the age of 80 years
- Active vomiting
- Patients with a permanent pacemaker, implantable cardioverter-defibrillator or REVEAL device
- Patients with any electronic/magnetic/mechanically controlled devices e.g. sacral nerve stimulators, bladder stimulators
- Patients with dysphagia, odynophagia or known swallowing disorder
- Patients with known Zenker's diverticulum
- Patients with suspected bowel obstruction or bowel perforation
- Patients with prior bowel obstruction
- Patients with gastroparesis or known gastric outlet obstruction
- Patients with known Crohn's disease
- Patients who are taking daily non-steroidal anti-inflammatory drugs (excluding prophylactic doses of aspirin) for more than six months
- Patients who have received abdominopelvic radiotherapy treatment
- Patients with a history of GI tract surgery (Billroth I, Billroth II, Oesophagectomy, gastrectomy or bariatric procedure)
- Patients that are pregnant or lactating
- Patients with altered mental status that would limit their ability to swallow
- Patients with allergy to conscious sedation, polyethylene glycol or metoclopramide
- Patients unwilling to swallow the capsule
- Patients with known dementia affecting ability to consent
- Patients who are unable to understand or speak English
- Patients unable to provide written informed consent
Sites / Locations
- Prince of Wales HospitalRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
MACE
Arm Description
Patients will receive MACE for IDA.
Outcomes
Primary Outcome Measures
Prevalence and nature of lesions in the upper GI tract, small bowel and colon that cause IDA
Prevalence and nature of lesions in the upper GI tract, small bowel and colon that cause IDA
Secondary Outcome Measures
Comparison of diagnostic performance between MACE and gastroscopy in the upper GI tract in detecting lesions that cause IDA
Comparison of diagnostic performance between MACE and gastroscopy in the upper GI tract in detecting lesions that cause IDA
Comparison of patient acceptability of MACE and gastroscopy by patient questionnaire
Comparison of patient acceptability of MACE and gastroscopy by patient questionnaire
Full Information
NCT ID
NCT04840433
First Posted
March 25, 2021
Last Updated
August 12, 2021
Sponsor
Chinese University of Hong Kong
1. Study Identification
Unique Protocol Identification Number
NCT04840433
Brief Title
Location of Lesions Responsible for Blood Loss in the Gastrointestinal (GI) Tract
Acronym
A-MACE
Official Title
Location of Lesions Responsible for Blood Loss in the Gastrointestinal (GI) Tract
Study Type
Interventional
2. Study Status
Record Verification Date
August 2021
Overall Recruitment Status
Unknown status
Study Start Date
April 12, 2021 (Actual)
Primary Completion Date
August 31, 2022 (Anticipated)
Study Completion Date
December 31, 2022 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Chinese University of Hong Kong
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to identify the prevalence, nature and location of lesions in the GI tract that may contribute to iron deficiency anaemia and compare diagnostic yied of the upper GI magnetic controlled capsule endoscopy with conventional gastroscopy.
Detailed Description
Iron deficiency anaemia (IDA) affects 2-5% of men and post-menopausal women (1). It is thought to occur as a consequence of gastrointestinal blood loss in the majority of cases. Studies suggest that gastroscopy identifies a possible cause in 25-58 % and colonoscopy in 25-33 % of cases. Because pathologies in both upper and lower gastrointestinal tract occur simultaneously in up to 26% of cases, current United Kingdom guidelines recommend both gastroscopy and colonoscopy for patients with IDA.
Wireless capsule endoscopy (CE) is a non-invasive form of endoscopy using a swallowable pill camera which produces images which can be viewed as a video. It is used routinely in clinical practice to examine the small bowel and colon and a role in upper GI investigation is emerging. We have experience of upper GI capsule endoscopy in over 100 patients who have declined conventional gastroscopy using a protocol involving positional change to move a capsule around a water-filled stomach (Ching et al., submitted for publication. It is much better tolerated than conventional endoscopy which requires oral or anal intubation, often following the administration of intravenous sedation and analgesia and incurs a small risk of perforation.Pathology in the small bowel was historically considered to account for only 5% of all gastrointestinal causes of anaemia . Consequently, current guidelines recommend small bowel capsule endoscopy only when IDA has recurred after treatment. However, it is accepted that as many as 30 % of patients with IDA undergoing bidirectional endoscopy have no significant abnormality identified, raising the possibility that the cause is located in the small bowel. The studies which identified that only 5% of IDA was due to small bowel pathology used radiological methods of small bowel imaging, before the advent of CE. Meta-analyses now show significantly better diagnostic yields of CE compared to small bowel radiology in patients with IDA (42% and 6%, respectively).
Although mostly performed in patients with recurrent or refractory (as opposed to first presentation of) anaemia, CE studies show a diagnostic yield of small bowel pathology in 66% and a tumour detection rate of as much as 10% . Even in patients of less than 50 years of age, 5% of patients are found to have tumours. Given the uncertainties about which pathologies cause anaemia, the failure to identify a cause using conventional bidirectional endoscopy in 30% and the availability of a highly sensitive, well tolerated small bowel investigative tool, our primary aim is to determine the incidence, nature and location of pathology in the gastrointestinal tract by performing small bowel capsule endoscopy in patients referred for gastroscopy and colonoscopy for the investigation of IDA.
Prior to passage through the pylorus and small bowel, capsules can now be moved around the stomach using a joystick-controlled robot magnet (Ankon Technologies, Shanghai, China). A multicentre study using this device showed a 90% sensitivity in the detection of gastric focal lesions compared to gastroscopy, irrespective of size or location of the lesion. We have also demonstrated that the diagnostic ability of capsules moved around the stomach either using simple patient positional change or external handheld magnets is comparable to gastroscopy. Patient tolerance significantly favoured CE in these studies and no patient suffered adverse effects. The diagnostic yield using magnetically assisted CE (MACE) of the upper gastrointestinal tract will be compared with gastroscopy as a secondary outcome measure in this study of patients with IDA.
Overall, this study aims to report on the prevalence of lesions in entire gastrointestinal tract by endoscopy in patients with IDA. This is novel as there has been no such study reporting pan enteric pathology by endoscopy in unselected patients with iron deficiency since the advent of CE in 2000. This is important because uncertainty about the likelihood that certain upper gastrointestinal and colonic pathologies, such as oesophagitis, gastritis, diverticulosis and colonic polyps, are the cause of IDA, is widely acknowledged. In up to 25% of patients synchronous upper and lower GI pathologies are found on gastroscopy and colonoscopy, but we are unsure of the rates and significance of synchronous small bowel pathologies in those deemed to have a cause found on gastroscopy or colonoscopy. If there are significant synchronous pathologies in the small bowel it may be that small bowel CE should become part of first line investigation. Furthermore, should MACE prove to be sensitive in upper GI pathology detection when compared to gastroscopy, it may have a role in investigating the stomach and small bowel simultaneously.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Iron Deficiency Anemia
Keywords
magnetically assisted capsule endoscopy
7. Study Design
Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
All subjects will be invited to have MACE before their endoscopy and colonoscopy.
Masking
None (Open Label)
Allocation
N/A
Enrollment
180 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
MACE
Arm Type
Experimental
Arm Description
Patients will receive MACE for IDA.
Intervention Type
Device
Intervention Name(s)
MACE
Intervention Description
Using magnetically assisted capsule endoscopy to examine oesophagus and stomach
Primary Outcome Measure Information:
Title
Prevalence and nature of lesions in the upper GI tract, small bowel and colon that cause IDA
Description
Prevalence and nature of lesions in the upper GI tract, small bowel and colon that cause IDA
Time Frame
1.5 years
Secondary Outcome Measure Information:
Title
Comparison of diagnostic performance between MACE and gastroscopy in the upper GI tract in detecting lesions that cause IDA
Description
Comparison of diagnostic performance between MACE and gastroscopy in the upper GI tract in detecting lesions that cause IDA
Time Frame
1.5 years
Title
Comparison of patient acceptability of MACE and gastroscopy by patient questionnaire
Description
Comparison of patient acceptability of MACE and gastroscopy by patient questionnaire
Time Frame
1.5 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male and female patients aged 18 years and over and up to but not exceeding 80 years
Patients presenting with IDA whom require gastroscopy and colonoscopy as per national guidelines (1)
Exclusion Criteria:
Patients who have contraindications to gastroscopy or colonoscopy
Patients under the age of 18 years
Patients over the age of 80 years
Active vomiting
Patients with a permanent pacemaker, implantable cardioverter-defibrillator or REVEAL device
Patients with any electronic/magnetic/mechanically controlled devices e.g. sacral nerve stimulators, bladder stimulators
Patients with dysphagia, odynophagia or known swallowing disorder
Patients with known Zenker's diverticulum
Patients with suspected bowel obstruction or bowel perforation
Patients with prior bowel obstruction
Patients with gastroparesis or known gastric outlet obstruction
Patients with known Crohn's disease
Patients who are taking daily non-steroidal anti-inflammatory drugs (excluding prophylactic doses of aspirin) for more than six months
Patients who have received abdominopelvic radiotherapy treatment
Patients with a history of GI tract surgery (Billroth I, Billroth II, Oesophagectomy, gastrectomy or bariatric procedure)
Patients that are pregnant or lactating
Patients with altered mental status that would limit their ability to swallow
Patients with allergy to conscious sedation, polyethylene glycol or metoclopramide
Patients unwilling to swallow the capsule
Patients with known dementia affecting ability to consent
Patients who are unable to understand or speak English
Patients unable to provide written informed consent
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Felix Sia
Phone
26370428
Email
felixsia@cuhk.edu.hk
First Name & Middle Initial & Last Name or Official Title & Degree
Thomas Lam
Phone
26370428
Email
thomaslam@cuhk.edu.hk
Facility Information:
Facility Name
Prince of Wales Hospital
City
Shatin
State/Province
New Territories
Country
Hong Kong
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
felix sia
Phone
26370428
Email
felixsia@cuhk.edu.hk
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
There is no plan to share individual participant data with other researchers
Learn more about this trial
Location of Lesions Responsible for Blood Loss in the Gastrointestinal (GI) Tract
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