CClinicalTrials.gg
CompletedNCT03412149Updated Apr 28, 2021

Three M Study (Malabsorption, Microbiota, Mini-Gastric Bypass)

An interventional study of Mini Gastric Bypass and Roux en Y Gastric Bypass in Obesity (Disorder), sponsored by University of Roma La Sapienza. Completed at 1 site in Italy. Open to participants aged 18 Years to 65 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2021-04-28.

Sponsored by University of Roma La Sapienza · Not applicable, Interventional, and Basic science

Phase
Not applicable
Study type
Interventional
Enrollment
90
Allocation
Randomized
Ages
18 Years to 65 Years
Sex
All
01

Study summary

Bariatric surgery represents the best therapeutic option to induce sustainable weight loss and to solve serious comorbidities improving the life-expectancy and the quality of life. Actually the choice of the procedure is based on the surgeon's and patients preference . Mini gastric bypass(MGB) is an emerging procedure offering excellent results in terms of weight loss and comorbidities (mainly metabolic) control. On the other hand, recent data indicated that the gut microbiota may mediate some of the beneficial effects of bariatric surgery and changes in the composition and diversity of the gut microbiota have been observed after RY Gastric Bypass (RYGB) in humans as well as in mice. However, there are no prospective investigations on Gut Microbiota changes after MGB, despite the procedure is described as "malabsorptive" and there are no studies comparing gut microbiota shift and malabsorption entity in humans after RYGB vs MGB. Thereafter prospective data on the incidence of bile reflux esophageal lesions after MGB are lacking.

The aim of the present multicentric prospective comparative study is to evaluate malabsorption and gut microbiota shift after laparoscopic RYGB vs MGB at 1 year.

02

Conditions studied

  • Obesity (Disorder)

Keywords

  • Malabsorption, Mini Gastric Bypass, Roux en Y Gastric Bypass
03

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • BMI 40-55 kg/m2
  • Non smokers
  • Primary Mini Gastric Bypass or Roux en Y Gastric Bypass without any concomitant surgeries except hiatal hernia repair
  • Enrollment in the two study groups will be on the basis of patient choice.

Exclusion criteria

Exclusion Criteria:

  • Smokers
  • Different bowel measurement (plus or minus 10%).
  • Conversion to open surgery, reoperation
  • Helicobacter Pylori positive previous or current
  • Free PPI 4 weeks before 6th month (after surgery)
  • Corticosteroids, vitamine E, fish oil treatment 2 months before surgery
  • Anti or pre- biotics treatment 2 months before surgery
  • Chronic gastrointestinal diseases or syndromes
  • Previous bariatric surgery (intragastric balloon excluded)
  • Previous resective bowel surgery
  • Previous pancreatic surgery
  • Previous Hepato BilioPancreatic surgery
  • Gallbladder gallstones
04

Study design

Phase
Not applicable
Primary purpose
Basic science
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
90 participants (actual)

Study arms

  • Active comparator
    Mini Gastric Bypass

    Mini Gastric Bypass: The gastric pouch will be performed starting below the incisura angularis (transverse resection 4 cm) on the lesser curvature (18).Then the stomach will be transected against a 36 Fr bougie up to the gastro-esophageal junction Then 1/3 of the small bowel will be excluded (approximately 200cms) and 3.5-4 cm gastro-jejunostomy will be performed by linear stapler.

    Procedure: Mini Gastric Bypass

  • Active comparator
    Roux en Y Gastric Bypass

    Roux en Y Gastric Bypass: The steps of the standard double loop RYGB technique will be followed (17). The gastric pouch will be created 7 cm from the gastro-esophageal junction to obtain a volume of 30-40 ml, and the length of the alimentary limb will be 150 cm and 3.5-4 cm gastro-jejunostomy will be performed by linear stapler. The length of the biliopancreatic limb will be from 65 to 75 cm beyond the ligament of Treitz. The lengths of both limbs should carefully measured with a graduated instrument. The mesenteric defects will be closed.

    Procedure: Roux en Y Gastric Bypass

Interventions

  • ProcedureMini Gastric Bypass

    Standardization of the techniques will be guaranteed: 1. Mini Gastric Bypass Arm 2. Roux en Y Gastric Bypass arm All patients will have intraoperative measurement of the whole length of bowel from Treitz ligament to the ileocecal junction (expected range 6-8 m).The common limb will be therefore about 2/3 of total small bowel length.

  • ProcedureRoux en Y Gastric Bypass

    Standardization of the techniques will be guaranteed: 1. Mini Gastric Bypass Arm 2. Roux en Y Gastric Bypass arm All patients will have intraoperative measurement of the whole length of bowel from Treitz ligament to the ileocecal junction (expected range 6-8 m).The common limb will be therefore about 2/3 of total small bowel length.

05

What researchers measure

Primary outcomes

  1. Gut Microbiota

    To evaluate and compare Roux en Y Gastric Bypass vs Mini Gastric Bypass microbiota profile shift 1 year after surgery and its impact on metabolic and nutritional status after surgery.

    Time frame: 0-6-12 Months

Secondary outcomes

  1. Glucagon - like peptide 1 (GLP-1)

    To measure GLP-1 plasma level before and 12 months after surgery in MGB vs RYGB patients

    Time frame: 0-12 Months

06

Study locations

1 site
  • ICOT Hospital
    Latina, 04100, Italy
07

References and documents

Publications

  • Milone M, De Placido G, Musella M, Sosa Fernandez LM, Sosa Fernandez LV, Campana G, Di Minno MN, Milone F. Incidence of Successful Pregnancy After Weight Loss Interventions in Infertile Women: a Systematic Review and Meta-Analysis of the Literature. Obes Surg. 2016 Feb;26(2):443-51. doi: 10.1007/s11695-015-1998-7. PubMed 26661108 ↗
  • Musella M, Apers J, Rheinwalt K, Ribeiro R, Manno E, Greco F, Cierny M, Milone M, Di Stefano C, Guler S, Van Lessen IM, Guerra A, Maglio MN, Bonfanti R, Novotna R, Coretti G, Piazza L. Efficacy of Bariatric Surgery in Type 2 Diabetes Mellitus Remission: the Role of Mini Gastric Bypass/One Anastomosis Gastric Bypass and Sleeve Gastrectomy at 1 Year of Follow-up. A European survey. Obes Surg. 2016 May;26(5):933-40. doi: 10.1007/s11695-015-1865-6. PubMed 26341086 ↗
  • Campanile FC, Boru CE, Rizzello M, Puzziello A, Copaescu C, Cavallaro G, Silecchia G. Acute complications after laparoscopic bariatric procedures: update for the general surgeon. Langenbecks Arch Surg. 2013 Jun;398(5):669-86. doi: 10.1007/s00423-013-1077-2. Epub 2013 Mar 22. PubMed 23519905 ↗
  • Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001 Jun;11(3):276-80. doi: 10.1381/096089201321336584. PubMed 11433900 ↗
  • Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005 Oct;15(9):1304-8. doi: 10.1381/096089205774512663. PubMed 16259892 ↗
  • Alexandrou A, Davis PA, Law S, Whooley BP, Murthy SC, Wong J. Esophageal cancer in patients with a history of distal gastrectomy. Arch Surg. 2002 Nov;137(11):1238-42. doi: 10.1001/archsurg.137.11.1238. PubMed 12413309 ↗
  • Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012 Dec;22(12):1827-34. doi: 10.1007/s11695-012-0726-9. PubMed 23011462 ↗
  • Bruzzi M, Rau C, Voron T, Guenzi M, Berger A, Chevallier JM. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015 Mar-Apr;11(2):321-6. doi: 10.1016/j.soard.2014.09.004. Epub 2014 Sep 16. PubMed 25614356 ↗
  • Noun R, Skaff J, Riachi E, Daher R, Antoun NA, Nasr M. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012 May;22(5):697-703. doi: 10.1007/s11695-012-0618-z. PubMed 22411569 ↗
  • Lee WJ, Lee YC, Ser KH, Chen SC, Chen JC, Su YH. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2011 Jul-Aug;7(4):486-91. doi: 10.1016/j.soard.2010.10.012. Epub 2010 Oct 30. PubMed 21159561 ↗
  • Wang W, Wei PL, Lee YC, Huang MT, Chiu CC, Lee WJ. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005 May;15(5):648-54. doi: 10.1381/0960892053923752. PubMed 15946455 ↗
  • Cavin JB, Voitellier E, Cluzeaud F, Kapel N, Marmuse JP, Chevallier JM, Msika S, Bado A, Le Gall M. Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats. Am J Physiol Gastrointest Liver Physiol. 2016 Sep 1;311(3):G492-500. doi: 10.1152/ajpgi.00197.2016. Epub 2016 Jul 14. PubMed 27418681 ↗
  • Graessler J, Qin Y, Zhong H, Zhang J, Licinio J, Wong ML, Xu A, Chavakis T, Bornstein AB, Ehrhart-Bornstein M, Lamounier-Zepter V, Lohmann T, Wolf T, Bornstein SR. Metagenomic sequencing of the human gut microbiome before and after bariatric surgery in obese patients with type 2 diabetes: correlation with inflammatory and metabolic parameters. Pharmacogenomics J. 2013 Dec;13(6):514-22. doi: 10.1038/tpj.2012.43. Epub 2012 Oct 2. PubMed 23032991 ↗
  • Tremaroli V, Karlsson F, Werling M, Stahlman M, Kovatcheva-Datchary P, Olbers T, Fandriks L, le Roux CW, Nielsen J, Backhed F. Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation. Cell Metab. 2015 Aug 4;22(2):228-38. doi: 10.1016/j.cmet.2015.07.009. PubMed 26244932 ↗
  • Liou AP, Paziuk M, Luevano JM Jr, Machineni S, Turnbaugh PJ, Kaplan LM. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013 Mar 27;5(178):178ra41. doi: 10.1126/scitranslmed.3005687. PubMed 23536013 ↗
  • Peterson LA, Zeng X, Caufield-Noll CP, Schweitzer MA, Magnuson TH, Steele KE. Vitamin D status and supplementation before and after bariatric surgery: a comprehensive literature review. Surg Obes Relat Dis. 2016 Mar-Apr;12(3):693-702. doi: 10.1016/j.soard.2016.01.001. Epub 2016 Jan 6. PubMed 27036669 ↗
  • Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis. 2008 Mar-Apr;4(2):166-72; discussion 172-3. doi: 10.1016/j.soard.2007.08.006. Epub 2007 Dec 19. PubMed 18069071 ↗
  • Musella M, Milone M, Deitel M, Kular KS, Rutledge R. What a Mini/One Anastomosis Gastric Bypass (MGB/OAGB) Is. Obes Surg. 2016 Jun;26(6):1322-3. doi: 10.1007/s11695-016-2168-2. No abstract available. PubMed 27091050 ↗
  • Donini LM, Brunani A, Sirtori A, Savina C, Tempera S, Cuzzolaro M, Spera G, Cimolin V, Precilios H, Raggi A, Capodaglio P; SIO-ISDCA Task Force. Assessing disability in morbidly obese individuals: the Italian Society of Obesity test for obesity-related disabilities. Disabil Rehabil. 2011;33(25-26):2509-18. doi: 10.3109/09638288.2011.575529. Epub 2011 May 4. PubMed 21542694 ↗

Study documents

  • Study protocol · Jan 23, 2018

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Undecided

08

Registry details

Key details

Study ID
NCT03412149
Lead sponsor
University of Roma La Sapienza
Responsible party
Gianfranco Silecchia (MD PhD Prof. G. Silecchia, University of Roma La Sapienza) — Principal investigator
First posted
Jan 26, 2018
Start date
Mar 21, 2018
Primary completion
Feb 19, 2020
Completion
Nov 19, 2020
Last update
Apr 28, 2021

Study contacts

Gianfranco Silecchia, MD PhD
principal investigator · University of Roma La Sapienza

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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