Duodenal-Ileal Diversion in Obese Patients Undergoing Primary Sleeve or Those With Inadequate Weight Loss After Sleeve
Primary Purpose
Obesity, Morbid
Status
Active
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Self Forming Magnets (SFM)
Sponsored by
About this trial
This is an interventional treatment trial for Obesity, Morbid
Eligibility Criteria
Inclusion Criteria:
- Age 22-65 years at screening
Obesity with Body Mass Index (BMI) ≥ 35 kg/m2 with at least one obesity related comorbidity or ≥ 40 but ≤ 50 kg/m2 with or without comorbidities at time of screening.
a. For SNAP-PS Cohort, subject should be at least 18 months from the initial sleeve gastrectomy and have failed to achieve at minimum 50% EWL
- If subject has obesity-related comorbidities such as hypertension, dyslipidemia, and sleep apnea, these comorbidities must be well-controlled.
- Able to understand and sign informed consent document
- Patient lives, and intends to remain, within a 300-km radius of study center for 24 months
- Willing to refrain from smoking during the study follow-up period
- If subject is female, she must commit to not becoming pregnant for 24 months and agree to use of contraceptives during this period and may not be nursing
Exclusion Criteria:
- Type 1 Diabetes
- Uncontrolled T2DM Fasting glucose ≥ 200 mg/dl (11.1 mmol/L) and/or hemoglobin A1c >10 or use of injectable insulin
- Any documented conditions for which endoscopy and/or laparoscopy would be contraindicated or history of previous technically difficult or failed endoscopy
- Contraindication to general anesthesia
- Clinically significant finding during procedural endoscopy such as presence of an unhealed ulcers, bleeding lesions, tumors or ischemic or necrotic tissue at target magnet deployment site
- Congenital or acquired anomalies of the GI tract, including atresias, stenosis, prior obstruction or malrotation
- Presence of a duodenal diverticulum (>10mm)
- Any previous major surgery on the stomach, duodenum, hepatobiliary tree (excluding laparoscopically removed gallbladder or prior sleeve gastrectomy for SNAP-PS cohort), pancreas or right colon
- History of chronic gastrointestinal disease (e.g., cirrhosis, inflammatory bowel disease) that in the opinion of the Investigator may preclude safe and complete study participation
- Uncontrolled severe hypertension (blood pressure >160/100mmHg)
- Pre-existing severe comorbid cardio-respiratory disease (e.g., congestive heart failure, uncontrolled cardiac arrhythmia, coronary artery disease, chronic obstructive lung disease requiring supplemental oxygen, pulmonary embolism, MI with prior 6 months)
- Liver biochemistries (ALT and AST) ≥ 3 times the upper limit of normal
- Uncorrectable coagulation disorder (platelets < 100,000, PT >2 seconds above control or INR >1.5) at time of procedure, Note: management of anti-platelet medications, when applicable, will follow standard practices of the institution
- Uncorrectable anemia (Hemoglobin < 11 g/dL in women and <12.5 g/dL in men)
- Specific genetic or hormonal cause of obesity such as Prader -Willi syndrome
- For females of child-bearing potential: Pregnancy or desire to be pregnant during the study
Sites / Locations
- Bariatric Medicine Institute
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
SNAP-S
SNAP-PS
Arm Description
Creation of a D-I diversion in participants undergoing primary sleeve gastrectomy (SNAP-S cohort)
Creation of a D-I diversion in participants who have experienced inadequate weight loss following sleeve gastrectomy (SNAP-PS cohort)
Outcomes
Primary Outcome Measures
Weight Loss
Total Body Weight Loss from baseline
Secondary Outcome Measures
Percent Responders
Percent of patients losing at least 10% of their baseline weight
%EWL
Mean Excess Weight Loss from baseline
Serum lipids
Mean change of serum lipids from baseline
Systolic/diastolic blood pressure
Mean percent change in systolic/diastolic blood pressure from baseline
Hemoglobin A1c
Mean change of hemoglobin A1c (in patients with Type 2 Diabetes (T2DM) from baseline
Full Information
NCT ID
NCT05064722
First Posted
September 22, 2021
Last Updated
September 25, 2023
Sponsor
GI Windows, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT05064722
Brief Title
Duodenal-Ileal Diversion in Obese Patients Undergoing Primary Sleeve or Those With Inadequate Weight Loss After Sleeve
Official Title
Initial Safety and Device Functionality of the Self-Forming Magnetic Anastomosis Device to Create a Duodenal-Ileal Diversion in Obese Patients Undergoing Primary Sleeve (SNAP-S) or Those With Inadequate Weight Loss After Sleeve (SNAP-PS)
Study Type
Interventional
2. Study Status
Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
November 8, 2021 (Actual)
Primary Completion Date
April 15, 2023 (Actual)
Study Completion Date
May 15, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
GI Windows, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The objectives of this study are to assess the initial safety and device functionality of the SFM Anastomosis System including delivery systems when used to create a dual-path duodenal-ileal (D-I) diversion either during sleeve gastrectomy (i.e., SNAP-S procedure) or patients with prior sleeve gastrectomy who experience inadequate weight loss (i.e., SNAP-PS procedure). Additionally, the study is designed to evaluate the potential of the SNAP-S/SNAP-PS procedures to induce weight loss and to improve metabolic comorbidities in obese subjects.
Detailed Description
This is a single-arm, single-center, early feasibility study to evaluate the use of the SFM Anastomosis System for creation of a D-I diversion in participants undergoing primary sleeve gastrectomy (SNAP-S cohort) or who have experienced inadequate weight loss following sleeve gastrectomy (SNAP-PS cohort) defined to be failure to achieve a minimum 50% EWL at least 18 months post sleeve gastrectomy. Five patients will be enrolled in each cohort. Adult male and female subjects between the ages of 22 and 65 years-old who are candidates for the primary or revisional surgery will be considered for participation.
Patients appearing to meet basic eligibility criteria and who sign the study specific consent form will be screened for enrollment into this study and will be assessed by a multidisciplinary research team with pre-procedure nutritional and medical evaluation (including psychological and behavioral evaluation by an internist/bariatrician).
Subjects meeting the inclusion and exclusion criteria and enrolled into the study will undergo a dual-path enteral diversion using the SFM anastomosis device in which the duodenum will be connected to the ileum with the creation of a side-by-side anastomosis using the SFM device and delivery systems. For subjects undergoing concurrent sleeve gastrectomy and D-I Diversion (SNAP-S cohort) it is anticipated that the D-I diversion will be created first followed by the sleeve gastrectomy (unless the investigator determines that the reverse order is more appropriate for a particular subject).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity, Morbid
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
10 (Actual)
8. Arms, Groups, and Interventions
Arm Title
SNAP-S
Arm Type
Experimental
Arm Description
Creation of a D-I diversion in participants undergoing primary sleeve gastrectomy (SNAP-S cohort)
Arm Title
SNAP-PS
Arm Type
Experimental
Arm Description
Creation of a D-I diversion in participants who have experienced inadequate weight loss following sleeve gastrectomy (SNAP-PS cohort)
Intervention Type
Device
Intervention Name(s)
Self Forming Magnets (SFM)
Intervention Description
To create the duodenal-ileal diversion, the duodenal magnet will be placed transorally in the proximal duodenum and the distal magnet will be placed in the ileum. Magnets are coupled and a compression induced anastomosis is created.
Primary Outcome Measure Information:
Title
Weight Loss
Description
Total Body Weight Loss from baseline
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Percent Responders
Description
Percent of patients losing at least 10% of their baseline weight
Time Frame
12 Months
Title
%EWL
Description
Mean Excess Weight Loss from baseline
Time Frame
12 Months
Title
Serum lipids
Description
Mean change of serum lipids from baseline
Time Frame
12 Months
Title
Systolic/diastolic blood pressure
Description
Mean percent change in systolic/diastolic blood pressure from baseline
Time Frame
12 Months
Title
Hemoglobin A1c
Description
Mean change of hemoglobin A1c (in patients with Type 2 Diabetes (T2DM) from baseline
Time Frame
12 Months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
22 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age 22-65 years at screening
Obesity with Body Mass Index (BMI) ≥ 35 kg/m2 with at least one obesity related comorbidity or ≥ 40 but ≤ 50 kg/m2 with or without comorbidities at time of screening.
a. For SNAP-PS Cohort, subject should be at least 18 months from the initial sleeve gastrectomy and have failed to achieve at minimum 50% EWL
If subject has obesity-related comorbidities such as hypertension, dyslipidemia, and sleep apnea, these comorbidities must be well-controlled.
Able to understand and sign informed consent document
Patient lives, and intends to remain, within a 300-km radius of study center for 24 months
Willing to refrain from smoking during the study follow-up period
If subject is female, she must commit to not becoming pregnant for 24 months and agree to use of contraceptives during this period and may not be nursing
Exclusion Criteria:
Type 1 Diabetes
Uncontrolled T2DM Fasting glucose ≥ 200 mg/dl (11.1 mmol/L) and/or hemoglobin A1c >10 or use of injectable insulin
Any documented conditions for which endoscopy and/or laparoscopy would be contraindicated or history of previous technically difficult or failed endoscopy
Contraindication to general anesthesia
Clinically significant finding during procedural endoscopy such as presence of an unhealed ulcers, bleeding lesions, tumors or ischemic or necrotic tissue at target magnet deployment site
Congenital or acquired anomalies of the GI tract, including atresias, stenosis, prior obstruction or malrotation
Presence of a duodenal diverticulum (>10mm)
Any previous major surgery on the stomach, duodenum, hepatobiliary tree (excluding laparoscopically removed gallbladder or prior sleeve gastrectomy for SNAP-PS cohort), pancreas or right colon
History of chronic gastrointestinal disease (e.g., cirrhosis, inflammatory bowel disease) that in the opinion of the Investigator may preclude safe and complete study participation
Uncontrolled severe hypertension (blood pressure >160/100mmHg)
Pre-existing severe comorbid cardio-respiratory disease (e.g., congestive heart failure, uncontrolled cardiac arrhythmia, coronary artery disease, chronic obstructive lung disease requiring supplemental oxygen, pulmonary embolism, MI with prior 6 months)
Liver biochemistries (ALT and AST) ≥ 3 times the upper limit of normal
Uncorrectable coagulation disorder (platelets < 100,000, PT >2 seconds above control or INR >1.5) at time of procedure, Note: management of anti-platelet medications, when applicable, will follow standard practices of the institution
Uncorrectable anemia (Hemoglobin < 11 g/dL in women and <12.5 g/dL in men)
Specific genetic or hormonal cause of obesity such as Prader -Willi syndrome
For females of child-bearing potential: Pregnancy or desire to be pregnant during the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel Cottam, MD
Organizational Affiliation
Bariatric Medicine Institute, Salt Lake City, UT
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Walter Medlin, MD
Organizational Affiliation
Bariatric Medicine Institute, Salt Lake City, UT
Official's Role
Principal Investigator
Facility Information:
Facility Name
Bariatric Medicine Institute
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84102
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
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Duodenal-Ileal Diversion in Obese Patients Undergoing Primary Sleeve or Those With Inadequate Weight Loss After Sleeve
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