search
Back to results

Endoscopic Myotomy of the Pylorus To Improve Emptying and Symptoms Trial (EMPTIES)

Primary Purpose

Gastroparesis

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Endoscopic per-oral pyloromyotomy (POP)
Diagnostic esophagogastroduodenoscopy (EGD) without pyloric disruption
Sponsored by
The Cleveland Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastroparesis

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female, aged 18-65
  2. Diagnosis of medically refractive gastroparesis by 4-hour non-extrapolated solid phase gastric emptying study within 90 days
  3. Completion of all routine assessments in our multidisciplinary gastroparesis clinic, which includes evaluation by gastroenterology, behavioral health, and nutrition specialists
  4. Ability to take oral medication and be willing to adhere to the post-procedure dietary and medication regimen
  5. For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation
  6. Stated willingness to comply with all study procedures and availability for the duration of the study
  7. Willingness and reasonable expectation that the individual will be able to travel to the study site for the intervention and each scheduled in-person assessment, as well as virtual assessments if necessary
  8. Ability to speak and read in the English Language

Exclusion Criteria:

  1. Active use of narcotic pain medication
  2. Presence of concomitant gastrointestinal transit disorder such as small bowel or colonic dysmotility
  3. Etiology of gastroparesis is post-surgical
  4. Pregnancy or lactation
  5. History of egg allergy
  6. Prior surgical intervention of the stomach or gastric pylorus
  7. Current parenteral nutrition
  8. Uncontrolled coagulopathy (platelet count <50,000 and INR>1.5) or use of other anticoagulant medications (with the exception of antiplatelet therapy)

Sites / Locations

  • Cleveland Clinic FoundationRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Sham Comparator

Arm Label

Endoscopic per-oral pyloromyotomy (POP)

Sham / Control Arm

Arm Description

Participants will undergo Endoscopic per-oral pyloromyotomy (POP).

Participants will undergo a diagnostic esophagogastroduodenoscopy (EGD) without pyloric disruption. Following the 12-week blinded trial period, these participants will be unblinded and offered Endoscopic per-oral pyloromyotomy (POP) if they remain symptomatic.

Outcomes

Primary Outcome Measures

Gastroparesis Cardinal Symptom Index (GCSI)
Change in Gastroparesis Cardinal Symptom Index (GCSI) at Baseline to 12 weeks post-procedure. Possible scores range from 0 (None) to 5 (Very Severe).

Secondary Outcome Measures

Gastric Emptying
Change in gastric emptying as measured by a standardized 4-hour solid scintigraphic gastric emptying study at Baseline to 12 weeks post-procedure
36-Item Short Form; Quality of Life Survey
Change in 36-Item Short Form Survey (SF-36) score from Baseline to 12 weeks post-procedure. The weighted sums of responses to questions in the survey produce eight separate scales which are scored from 0-100, with zero indication maximum disability and one hundred indicating no disability in that domain.

Full Information

First Posted
August 19, 2021
Last Updated
March 20, 2023
Sponsor
The Cleveland Clinic
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
search

1. Study Identification

Unique Protocol Identification Number
NCT05039424
Brief Title
Endoscopic Myotomy of the Pylorus To Improve Emptying and Symptoms Trial
Acronym
EMPTIES
Official Title
A Randomized, Sham-controlled Trial: Endoscopic Myotomy of the Pylorus To Improve Emptying and Symptoms (EMPTIES)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 23, 2022 (Actual)
Primary Completion Date
July 2026 (Anticipated)
Study Completion Date
July 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The Cleveland Clinic
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

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
A randomized clinical trial comparing endoscopic per-oral pyloromyotomy (POP) versus a control sham intervention (diagnostic esophagogastroduodenoscopy (EGD) without pyloric disruption) in patients with medically refractory gastroparesis.
Detailed Description
A comparative effectiveness, single center (with two surgical units), randomized (1:1) study of endoscopic per-oral pyloromyotomy (POP) versus a control sham intervention (diagnostic esophagogastroduodenoscopy (EGD) without pyloric disruption) in adult patients with medically refractory gastroparesis who have failed management with dietary, lifestyle, and pharmacological therapy for at least six months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastroparesis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
A comparative effectiveness, single center (with two surgical units), randomized (1:1) study of POP vs. sham endoscopic surveillance in patients with medically refractory gastroparesis. This study will also include a crossover approach, offering POP to patients randomized to the sham arm, if they remain symptomatic at 12 weeks post randomization.
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Endoscopic per-oral pyloromyotomy (POP)
Arm Type
Active Comparator
Arm Description
Participants will undergo Endoscopic per-oral pyloromyotomy (POP).
Arm Title
Sham / Control Arm
Arm Type
Sham Comparator
Arm Description
Participants will undergo a diagnostic esophagogastroduodenoscopy (EGD) without pyloric disruption. Following the 12-week blinded trial period, these participants will be unblinded and offered Endoscopic per-oral pyloromyotomy (POP) if they remain symptomatic.
Intervention Type
Procedure
Intervention Name(s)
Endoscopic per-oral pyloromyotomy (POP)
Intervention Description
Per-oral pyloromyotomy (POP), alternatively knows as gastric per-oral endoscopic myotomy (G-POEM), accomplishes longitudinal division of the pylorus using an endoscope. This procedure involves utilizing endoscopic electrosurgical knife to make an incision in the gastric mucosa and develop a submucosal tunnel to visualize the pyloric ring. The pyloric ring is divided longitudinally, and the mucosotomy incision is sealed with endoscopic clips.
Intervention Type
Procedure
Intervention Name(s)
Diagnostic esophagogastroduodenoscopy (EGD) without pyloric disruption
Intervention Description
While under general anesthesia, a standard gastroscope is introduced and a diagnostic upper endoscopy is performed. The operator talks through the procedure steps as if completing POP. The gastroscope is withdrawn and the patient is extubated.
Primary Outcome Measure Information:
Title
Gastroparesis Cardinal Symptom Index (GCSI)
Description
Change in Gastroparesis Cardinal Symptom Index (GCSI) at Baseline to 12 weeks post-procedure. Possible scores range from 0 (None) to 5 (Very Severe).
Time Frame
Baseline, 12 weeks post-procedure
Secondary Outcome Measure Information:
Title
Gastric Emptying
Description
Change in gastric emptying as measured by a standardized 4-hour solid scintigraphic gastric emptying study at Baseline to 12 weeks post-procedure
Time Frame
Baseline, 12 weeks post-procedure
Title
36-Item Short Form; Quality of Life Survey
Description
Change in 36-Item Short Form Survey (SF-36) score from Baseline to 12 weeks post-procedure. The weighted sums of responses to questions in the survey produce eight separate scales which are scored from 0-100, with zero indication maximum disability and one hundred indicating no disability in that domain.
Time Frame
Baseline,12 weeks post-procedure

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: Male or female, aged 18-65 Diagnosis of medically refractive gastroparesis by 4-hour non-extrapolated solid phase gastric emptying study within 90 days Completion of all routine assessments in our multidisciplinary gastroparesis clinic, which includes evaluation by gastroenterology, behavioral health, and nutrition specialists Ability to take oral medication and be willing to adhere to the post-procedure dietary and medication regimen For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation Stated willingness to comply with all study procedures and availability for the duration of the study Willingness and reasonable expectation that the individual will be able to travel to the study site for the intervention and each scheduled in-person assessment, as well as virtual assessments if necessary Ability to speak and read in the English Language Exclusion Criteria: Active use of narcotic pain medication Presence of concomitant gastrointestinal transit disorder such as small bowel or colonic dysmotility Etiology of gastroparesis is post-surgical Pregnancy or lactation History of egg allergy Prior surgical intervention of the stomach or gastric pylorus Current parenteral nutrition Uncontrolled coagulopathy (platelet count <50,000 and INR>1.5) or use of other anticoagulant medications (with the exception of antiplatelet therapy)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Karim Kheniser
Phone
2164449941
Email
khenisk@ccf.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Matthew Allemang, MD
Organizational Affiliation
The Cleveland Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cleveland Clinic Foundation
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Matthew Allemang, MD
Phone
216-491-7861
Email
ALLEMAM@ccf.org

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
17950441
Citation
Hasler WL. Gastroparesis: symptoms, evaluation, and treatment. Gastroenterol Clin North Am. 2007 Sep;36(3):619-47, ix. doi: 10.1016/j.gtc.2007.07.004.
Results Reference
background
PubMed Identifier
18047541
Citation
Wang YR, Fisher RS, Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995-2004. Am J Gastroenterol. 2008 Feb;103(2):313-22. doi: 10.1111/j.1572-0241.2007.01658.x. Epub 2007 Nov 28.
Results Reference
background
PubMed Identifier
28402773
Citation
Mayer-Davis EJ, Lawrence JM, Dabelea D, Divers J, Isom S, Dolan L, Imperatore G, Linder B, Marcovina S, Pettitt DJ, Pihoker C, Saydah S, Wagenknecht L; SEARCH for Diabetes in Youth Study. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002-2012. N Engl J Med. 2017 Apr 13;376(15):1419-1429. doi: 10.1056/NEJMoa1610187.
Results Reference
background
PubMed Identifier
15129893
Citation
Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J. Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Qual Life Res. 2004 May;13(4):833-44. doi: 10.1023/B:QURE.0000021689.86296.e4.
Results Reference
background
PubMed Identifier
12848636
Citation
Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J. Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther. 2003 Jul 1;18(1):141-50. doi: 10.1046/j.1365-2036.2003.01612.x.
Results Reference
background
PubMed Identifier
16553582
Citation
Abell TL, Bernstein RK, Cutts T, Farrugia G, Forster J, Hasler WL, McCallum RW, Olden KW, Parkman HP, Parrish CR, Pasricha PJ, Prather CM, Soffer EE, Twillman R, Vinik AI. Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil. 2006 Apr;18(4):263-83. doi: 10.1111/j.1365-2982.2006.00760.x.
Results Reference
background
PubMed Identifier
28110376
Citation
Yu D, Ramsey FV, Norton WF, Norton N, Schneck S, Gaetano T, Parkman HP. The Burdens, Concerns, and Quality of Life of Patients with Gastroparesis. Dig Dis Sci. 2017 Apr;62(4):879-893. doi: 10.1007/s10620-017-4456-7. Epub 2017 Jan 21.
Results Reference
background
PubMed Identifier
27775961
Citation
Lacy BE, Crowell MD, Mathis C, Bauer D, Heinberg LJ. Gastroparesis: Quality of Life and Health Care Utilization. J Clin Gastroenterol. 2018 Jan;52(1):20-24. doi: 10.1097/MCG.0000000000000728.
Results Reference
background
PubMed Identifier
14572555
Citation
Jones MP, Maganti K. A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol. 2003 Oct;98(10):2122-9. doi: 10.1111/j.1572-0241.2003.07721.x.
Results Reference
background
PubMed Identifier
26246804
Citation
Lal N, Livemore S, Dunne D, Khan I. Gastric Electrical Stimulation with the Enterra System: A Systematic Review. Gastroenterol Res Pract. 2015;2015:762972. doi: 10.1155/2015/762972. Epub 2015 Jul 12.
Results Reference
background
PubMed Identifier
15836452
Citation
Ramkumar D, Schulze KS. The pylorus. Neurogastroenterol Motil. 2005 Jun;17 Suppl 1:22-30. doi: 10.1111/j.1365-2982.2005.00664.x.
Results Reference
background
PubMed Identifier
3699409
Citation
Mearin F, Camilleri M, Malagelada JR. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology. 1986 Jun;90(6):1919-25. doi: 10.1016/0016-5085(86)90262-3.
Results Reference
background
PubMed Identifier
25667022
Citation
Koch KL, Calles-Escandon J. Diabetic gastroparesis. Gastroenterol Clin North Am. 2015 Mar;44(1):39-57. doi: 10.1016/j.gtc.2014.11.005.
Results Reference
background
PubMed Identifier
24529808
Citation
Toro JP, Lytle NW, Patel AD, Davis SS Jr, Christie JA, Waring JP, Sweeney JF, Lin E. Efficacy of laparoscopic pyloroplasty for the treatment of gastroparesis. J Am Coll Surg. 2014 Apr;218(4):652-60. doi: 10.1016/j.jamcollsurg.2013.12.024. Epub 2013 Dec 24.
Results Reference
background
PubMed Identifier
21720926
Citation
Hibbard ML, Dunst CM, Swanstrom LL. Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg. 2011 Sep;15(9):1513-9. doi: 10.1007/s11605-011-1607-6. Epub 2011 Jul 1.
Results Reference
background
PubMed Identifier
27036896
Citation
Lebares C, Swanstrom LL. Per-Oral Pyloromyotomy (POP): An Emerging Application of Submucosal Tunneling for the Treatment of Refractory Gastroparesis. Gastrointest Endosc Clin N Am. 2016 Apr;26(2):257-270. doi: 10.1016/j.giec.2015.12.012.
Results Reference
background
PubMed Identifier
28752406
Citation
Allemang MT, Strong AT, Haskins IN, Rodriguez J, Ponsky JL, Kroh M. How I Do It: Per-Oral Pyloromyotomy (POP). J Gastrointest Surg. 2017 Nov;21(11):1963-1968. doi: 10.1007/s11605-017-3510-2. Epub 2017 Jul 27.
Results Reference
background
PubMed Identifier
28567693
Citation
Rodriguez JH, Haskins IN, Strong AT, Plescia RL, Allemang MT, Butler RS, Cline MS, El-Hayek K, Ponsky JL, Kroh MD. Per oral endoscopic pyloromyotomy for refractory gastroparesis: initial results from a single institution. Surg Endosc. 2017 Dec;31(12):5381-5388. doi: 10.1007/s00464-017-5619-5. Epub 2017 May 31.
Results Reference
background
PubMed Identifier
30004920
Citation
Rodriguez J, Strong AT, Haskins IN, Landreneau JP, Allemang MT, El-Hayek K, Villamere J, Tu C, Cline MS, Kroh M, Ponsky JL. Per-oral Pyloromyotomy (POP) for Medically Refractory Gastroparesis: Short Term Results From the First 100 Patients at a High Volume Center. Ann Surg. 2018 Sep;268(3):421-430. doi: 10.1097/SLA.0000000000002927.
Results Reference
background
PubMed Identifier
28275310
Citation
Woodhouse S, Hebbard G, Knowles SR. Psychological controversies in gastroparesis: A systematic review. World J Gastroenterol. 2017 Feb 21;23(7):1298-1309. doi: 10.3748/wjg.v23.i7.1298.
Results Reference
background
PubMed Identifier
9824125
Citation
Soykan I, Sivri B, Sarosiek I, Kiernan B, McCallum RW. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998 Nov;43(11):2398-404. doi: 10.1023/a:1026665728213.
Results Reference
background
PubMed Identifier
17944739
Citation
Arts J, Holvoet L, Caenepeel P, Bisschops R, Sifrim D, Verbeke K, Janssens J, Tack J. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007 Nov 1;26(9):1251-8. doi: 10.1111/j.1365-2036.2007.03467.x.
Results Reference
background
PubMed Identifier
20538073
Citation
McCallum RW, Snape W, Brody F, Wo J, Parkman HP, Nowak T. Gastric electrical stimulation with Enterra therapy improves symptoms from diabetic gastroparesis in a prospective study. Clin Gastroenterol Hepatol. 2010 Nov;8(11):947-54; quiz e116. doi: 10.1016/j.cgh.2010.05.020. Epub 2010 Jun 9.
Results Reference
background
PubMed Identifier
23895180
Citation
McCallum RW, Sarosiek I, Parkman HP, Snape W, Brody F, Wo J, Nowak T. Gastric electrical stimulation with Enterra therapy improves symptoms of idiopathic gastroparesis. Neurogastroenterol Motil. 2013 Oct;25(10):815-e636. doi: 10.1111/nmo.12185. Epub 2013 Jul 29.
Results Reference
background
PubMed Identifier
28504312
Citation
Gonzalez JM, Benezech A, Vitton V, Barthet M. G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome. Aliment Pharmacol Ther. 2017 Aug;46(3):364-370. doi: 10.1111/apt.14132. Epub 2017 May 15.
Results Reference
background
PubMed Identifier
26140897
Citation
Mancini SA, Angelo JL, Peckler Z, Philp FH, Farah KF. Pyloroplasty for Refractory Gastroparesis. Am Surg. 2015 Jul;81(7):738-46.
Results Reference
background
PubMed Identifier
27354102
Citation
Khashab MA, Ngamruengphong S, Carr-Locke D, Bapaye A, Benias PC, Serouya S, Dorwat S, Chaves DM, Artifon E, de Moura EG, Kumbhari V, Chavez YH, Bukhari M, Hajiyeva G, Ismail A, Chen YI, Chung H. Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2017 Jan;85(1):123-128. doi: 10.1016/j.gie.2016.06.048. Epub 2016 Jun 25.
Results Reference
background
PubMed Identifier
20304396
Citation
Gersin KS, Rothstein RI, Rosenthal RJ, Stefanidis D, Deal SE, Kuwada TS, Laycock W, Adrales G, Vassiliou M, Szomstein S, Heller S, Joyce AM, Heiss F, Nepomnayshy D. Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc. 2010 May;71(6):976-82. doi: 10.1016/j.gie.2009.11.051. Epub 2010 Mar 20.
Results Reference
background

Learn more about this trial

Endoscopic Myotomy of the Pylorus To Improve Emptying and Symptoms Trial

We'll reach out to this number within 24 hrs