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CompletedNCT03456752Updated Feb 11, 2021

Perioperative Dexamethasone on Postoperative Outcome in IBD

A Phase 2 interventional study of Dexamethasone and Normal saline in Inflammatory Bowel Diseases, Dexamethasone and Postoperative Ileus, sponsored by Jinling Hospital, China. Completed at 1 site in China. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2021-02-11.

Sponsored by Jinling Hospital, China · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
302
Allocation
Randomized
Ages
18 Years to 75 Years
Sex
All
01

Study summary

The objective of this RCT is to determine the efficacy of a single preoperative dose of Dexamethasone for accelerating the recovery and reducing the incidence of postoperative complications in adult patients undergoing intestinal resection for inflammatory bowel disease.

Read the detailed description

Patients undergoing surgery for IBD is associated with increased inflammatory response and incidence of prolonged ileus after surgery compared to other colorectal disease such as CRC. Previous studies have revealed that preoperative administration of glucocorticosteroids(GCs) decreased complications and length of postoperative length of hospital after major abdominal surgery as a likely consequence of attenuating the postsurgical inflammatory response. Also, a single dose of GCs did not increase complications in colorectal surgery. The aim of the study is to examine whether a single dose of dexamethasone prior to induction of anesthesia could promote the recovery of patients and reduce the incidence of prolonged ileus after surgery for IBD

02

Conditions studied

  • Inflammatory Bowel Diseases
  • Dexamethasone
  • Postoperative Ileus
  • Postoperative Complications

Keywords

  • Inflammatory Bowel Diseases
  • Glucocorticosteroids
  • Postoperative Outcome
03

Who can participate

Ages eligible
18 Years to 75 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Patients undergoing elective open and laparoscopic small and large bowel operations for IBD, including Crohn's Disease(CD) and Ulcerative Colitis (UC).
  2. ASA I-III

Exclusion criteria

Exclusion Criteria:

  1. Diabetes or hyperglycemia
  2. Active gastric ulceration confirmed endoscopically
  3. Presence of ongoing infection (such as IAS) or infective chronic diseases
  4. Currently receiving systemic therapy with glucocorticoids with prednisolone >=20mg for over 6 weeks within 30 days prior to surgery.
  5. Emergent surgery
  6. Acute angle glaucoma
  7. Pregnancy
  8. Under 18 years of age
  9. Known adverse reaction to dexamethasone
  10. Extensive adhesiolysis
  11. Carcinogenesis of intestinal tract
04

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Investigator)
Enrollment
302 participants (actual)

Study arms

  • Experimental
    Dexamethasone

    Dexamethasone 8mg intravenously prior to anesthesia induction

    Drug: Dexamethasone

  • Placebo comparator
    Control

    Normal Saline 1.6ml intravenously prior to anesthesia induction

    Drug: Normal saline

Interventions

  • DrugDexamethasone

    Dexamethasone 8mg intravenously prior to induction of anesthesia

  • DrugNormal saline

    Normal saline 1.6ml intravenously prior to induction of anesthesia

05

What researchers measure

Primary outcomes

  1. Prolonged ileus

    Prolonged POI was defined as if two or more of the following five criteria are met on day 4 postoperatively: nausea or vomiting; inability to tolerate an oral diet over last 24 h; absence of flatus over last 24 h; abdominal distension; and radiologic confirmation.

    Time frame: Day 30

Secondary outcomes

  1. PONV(Postoperative nausea and vomiting) and additional antiemetics given within 24hr after surgery

    the incidence of any nausea, emetic episodes (retching or vomiting),or both (i.e., postoperative nausea and vomiting) during the first 24 postoperative hours.

    Time frame: 24hr

  2. Postoperative pain on POD 1, 3, and 5

    Visual analog scale (VAS) for pain description (0-10 visual analogue pain scale)

    Time frame: up to 1 week

  3. Postoperative fagitue score on POD 1, 3, and 5

    Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale (Version 4). The FACIT-IT score is a 13-item tool that measures an individual's level of fatigue during their usual daily activities over the past week. The level of fatigue is measured on a four point Likert scale (4 = not at all fatigued to 0 = very much fatigued)

    Time frame: up to 1 week

  4. GI-2 recovery

    time to upper (first tolerance of solid food) and lower (first bowel movement) GI recovery (GI-2).

    Time frame: Day 30

  5. Blood WBC levels, preoperative and on postoperative 1,3 and 5

    Blood WBC levels, preoperative and on postoperative 1,3 and 5

    Time frame: Day 30

  6. Blood neutrophil percentage, preoperative and on postoperative 1,3 and 5

    Blood neutrophil percentage, preoperative and on postoperative 1,3 and 5

    Time frame: Day 30

  7. Serum C-reactive protein (CRP) level, preopperative and on postoperative 1,3 and 5

    Serum C-reactive protein (CRP) level, preopperative and on postoperative 1,3 and Serum C-reactive protein (CRP) level, preopperative and on postoperative 1,3 and Serum C-reactive protein (CRP) level, preopperative and on postoperative 1,3 and Serum C-reactive protein (CRP) level, preopperative and on postoperative 1,3 and

    Time frame: Day 30

  8. Serum Interleukin-6 (IL-6) level, preopperative and on postoperative 1,3 and 5

    Serum Interleukin-6 (IL-6) level, preopperative and on postoperative 1,3 and 5

    Time frame: Day 30

  9. Serum procalcitonin (PCT) level, preopperative and on postoperative 1,3 and 5

    Serum procalcitonin (PCT) level, preopperative and on postoperative 1,3 and 5

    Time frame: Day 30

  10. Body composition, preoperative and on POD 1

    body composition was determined using Bioelectrical impedance analysis (BIA)

    Time frame: Day 30

  11. Postoperative length of stay

    in days

    Time frame: Day 90

  12. Postoperative morbidity

    Documented using comprehensive complication index(CCI)

    Time frame: Day 30

  13. Postoperative surgical site infections (SSIs)

    Including superficial SSIs and deep SSIs.

    Time frame: Day 30

  14. Overall cost of treatment

    In Chinese Yuan (CNY)

    Time frame: up to 1 year

06

Study locations

1 site
  • Department of Generay Surgery, Jinling hosptal, Medical School of Nanjing University
    Nanjing, Jiangsu 210000, China
07

References and documents

Publications

  • Zhang T, Xu Y, Yao Y, Jin L, Liu H, Zhou Y, Gu L, Ji Q, Zhu W, Gong J. Randomized Controlled Trial: Perioperative Dexamethasone Reduces Excessive Postoperative Inflammatory Response and Ileus After Surgery for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2021 Oct 20;27(11):1756-1765. doi: 10.1093/ibd/izab065. PubMed 33749741 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03456752
Lead sponsor
Jinling Hospital, China
Responsible party
Jianfeng Gong (Associate Professor, Jinling Hospital, China) — Principal investigator
First posted
Mar 7, 2018
Start date
Jun 1, 2018
Primary completion
Dec 13, 2019
Completion
Jan 13, 2020
Last update
Feb 11, 2021

Study contacts

Jianfeng Gong, MD
principal investigator · Jinling Hospital, China

Oversight

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

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