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
About this trial
This is an interventional treatment trial for Gastroparesis
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)
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
NCT ID
NCT05039424
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)
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
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Endoscopic Myotomy of the Pylorus To Improve Emptying and Symptoms Trial
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