An interventional study of APC and Endoscopic Suture Technique (OverStitch TM) in Obesity, sponsored by University of Sao Paulo General Hospital. Status unknown at 1 site in Brazil. Open to participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2017-03-29.
Sponsored by University of Sao Paulo General Hospital · Not applicable, Interventional, and Treatment
Obesity is a worldwide health and sociopolitical problem. Excessive body-weight currently affects over 50% of the Brazilian population. It has been well established that obesity is an independent health risk. Obese individuals are at increased to extremely high risk for many diseases and for early death relative to those with normal weights and waist circumferences. The increased disease susceptibility for this subset of patients includes hypertension, stroke, hyperlipidemia, sleep apnea, Type 2 diabetes, neoplasms, Gastro-Esophageal Reflux Disease, and musculoskeletal disorders.
Bariatric surgery is the most effective treatment for obesity. As bariatrics grow, the number of patients suffering from surgical-related complications also grows. One of the most worrisome long-term complications is weight regain, once the patient may be again affected by overweight-related comorbidities and face again pre-operative esthetic issues.
This trial focus on testing efficacy and safety of two endoscopic revisional procedures in patients suffering from weight regain following Roux-en-Y Gastric Bypass: Ablation with Argon Plasma Coagulation (APC) versus APC plus Endoscopic Full-thickness Suture (with Apollo Overstitch device). Pouch volume, gastric emptying and gut hormones changes will also be assessed.
Obesity is a worldwide health and sociopolitical issue. Excessive body-weight currently affects over 50% of the Brazilian population and around 13% of all world population. It has been well established that obesity is an independent risk factor. Obese individuals are at increased risk of diseases and earlier death compared to those with normal weight and waist circumferences. The increased disease susceptibility of this subset of patients includes hypertension, stroke, hyperlipidemia, sleep apnea, Type 2 diabetes, neoplasms, GERD, and musculoskeletal disorders.
Obese patients and their physicians have increasingly turned to surgery to solve the excess weight issue and the frequent co-morbid conditions that impact their health and quality of life. Roux-en-Y Gastric Bypass (RYGB) and Laparoscopic Gastric Banding (LGB) comprise around 70% of all weight loss procedures performed every year. They induce significant and perennial weight loss and reduce or eliminate associated co-morbid diseases, including Type 2 diabetes. Despite improvements in postoperative morbidity and mortality rates over the years, (in part due to the use of a laparoscopic approach), these procedures still carry significant risk. Recent studies have shown mortality rates with RYGB as high as 1.9%, and complications associated with LGB as high as 13%. Nonetheless, a secondary bariatric procedure due to weight regain carries significant complication rates and worse outcomes, compared to the primary procedure. Consequently, less invasive techniques are needed to reduce such risks.
Gastric restriction is an important principle of both RYGB and LGB. The OverStitchTM Endoscopic Suturing System (Apollo Endosurgery, Inc. Austin, Texas) is an approved device designed to endoscopic placement of suture(s) and approximation of soft tissue. This system offers the assistant doctor the ability to restrict gastric pouch size by approximating tissue endoluminally through an incisionless (per-oral) approach. The use of this system has the potential to reduce the complications associated with the current surgical approach but still reaching the desired gastric restriction. The OverStitch has safely been used clinically for a great number of procedures that demanded an incisionless or minimally invasive approach, including endoluminal revisions for post-bypass gastric stoma and/or pouch dilatation, post-bypass fistulae repair, and oversewing of marginal ulcers.
Besides this suturing device, other endoscopic methods have already been used to reduce dilated stoma. Among them, ablation with argon plasma coagulation (APC) is one of the most important since this device is worldly available and presents an acceptable cost. Recent studies associate APC prior to endoscopic suture and initial evidence supports superiority of this association.
However, literature is still lacking of studies to support the use of APC associated with endoscopic suturing instead of APC alone. Therefore, the main focus of this study is to directly compare short and long-term effectiveness and safety of APC versus APC plus Endoscopic Full-thickness suture with OverStitch device in patients suffering from weight regain following RYGB.
Moreover, gut hormones regulation regarding bariatric and revisional procedures have been studied recently and evidence suggests that hormonal changes may be an important factor in weight loss. Three of the most important gut hormones regarding weight balance are ghrelin, GLP1 and peptide YY. Ghrelin is known as hunger hormone. It is produced by cells in gastric fundus. Glucagon-like Peptide 1 (GLP1) and Peptide YY (PYY) are both hormones that regulate satiety and are produced by L cells along distal intestine. Evidence in bariatric show that after long-term ghrelin levels diminish while GLP and PYY reach higher post-prandial peak. Regarding revisional endoscopic therapy, gut hormone changes have never been studied. That is also focus of this study as secondary outcome.
University of Sao Paulo General Hospital is the lead sponsor of 595 studies on the registry; 98 are open to participants now.
Of its 8 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
This group own twenty patients who met all the inclusion criteria. These will be treated with APC.
Procedure: APC
This group own twenty patients who met all the inclusion criteria. These will be treated with APC plus Endoscopic Suture Technique (OverStitch TM).
Procedure: APC · Device: Endoscopic Suture Technique (OverStitch TM)
Ablation of the dilated gastro-jejunal anastomosis with Argon Plasma Coagulation. This procedure induces cicatrization process around the stoma and propitiates its reduction.
OverStitchTM Endoscopic Suturing System. Stitches will be placed per-orally with the aforementioned device around the dilated stoma in order to reduce the diameter of the anastomosis. In this group, ablation with APC will be done immediately before suturing.
Also known as: Apollo Overstitch
Absolute Weight Loss
Absolute Weight Loss will be assessed through subtraction of the pre-operative weight and the weight at follow-up, and will be measured in kilograms (kgs).
Time frame: This outcome will be assessed at 12 months after the procedure
Excess Weight Loss
Excess Weight Loss will be assessed through calculation of the percentage of the overweight lost after the procedure at follow-up. Excess Weight is defined as the weight over BMI of 25 for each patient. Excess Weight Loss will be expressed as percentage (%).
Time frame: This outcome will be assessed at 12 months after the procedure
Abdominal Circumference Reduction
Subtraction between baseline abdominal circumference and this measure at follow-up. This outcome will expressed in centimeters (cm).
Time frame: This outcome will be assessed at 12 months after the procedure
BMI reduction
Subtraction between baseline BMI and this measure at follow-up. This outcome will expressed in kg/m2.
Time frame: This outcome will be assessed at 12 months after the procedure.
Diabetes improvement
This outcome will be assessed through a glucose tolerance test performed at baseline and another one performed at 1 year follow-up.
Time frame: This outcome will be assessed at baseline and 12 months after the procedure.
Occurrence of Adverse Events
Adverse events such as perforation, bleeding, pain, stenosis, vomiting, need of surgery.
Time frame: This outcome will be assessed continually after the procedure.
Quality of Life Improvement
This outcome will be assessed with SF-36 questionnaire.
Time frame: This outcome will be assessed at baseline and at 12 months.
Eating Habits Evaluation
This outcome will evaluate if there is any change in eating habits with TFEQ-R21 questionnaire
Time frame: This outcome will be assessed at baseline and at 12 months.
Gut Hormones Response
This outcome will evaluate at fasting, 30, 60, 90 and 120 minutes post-prandial the hormonal variation regarding Ghrelin, GLP1 and PYY
Time frame: This outcome will be assessed at baseline and at 12 months.
Gastric (Pouch) Emptying
This outcome will evaluate retention rate through scintigraphy.
Time frame: This outcome will be assessed at baseline and at 12 months.
CT Volumetry of the Gastric Pouch
This outcome will evaluate volumetry of the pouch before and 12 months after procedure through tridimensional computed tomography.
Time frame: This outcome will be assessed at baseline and at 12 months.
Plan to share: No
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University of Sao Paulo General Hospital